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Full text of "Bulletin of the University of Maryland School of Medicine 1971"

HEALTH SCIENCES LIBBARX 

UNIVERSITY OF MARY.LANQ 

BALTIMORE 



Digitized by the Internet Archive 

in 2011 with funding from 

LYRASIS IVIembers and Sloan Foundation 



http://www.archive.org/details/bulletinofuniver5656 



mmm 







January, 1971 volume 56 • number 



PUBLISHED FOUR TIMES A YEAR 
JANUARY, APRIL, JULY AND OCTOBER 



SCHOOL OF MEDICINE OF THE UNIVERSITY OF MARYLAND 
AND THE MEDICAL ALUMNI ASSOCIATION 




Second class mailing privileg^mfflorized at Baltimore, Maryland 



Volume 56 

Number 1 

JANUARY, 1971 



HEALTH SCIENCES LIBRARY 

UNIVERSITY OP MARYLAND 

BALTIMORE 



BULLETIN 




JOHN A. WAGNER, B.S., M.D. 

Chief Editor 



JAN K. WALKER 

Managing Editor 

EDITORIAL BOARD 
Edward F. Cotter, M.D. 

George Entwisie, B.S., M.D. 



Robert B. Goldstein, M.D. 



John C. Krantz. Jr., Se. D.. Ph. D. 



Arlic Mansberger, M.D. 



William H. Mosberg, B.S.. M.D. 



Francis W. O'Brien 



John H. Moxley, ill, M.D. 
(ex •officio) 



Theodore Kardash, M.D. 
(ex-officio) 



School of Medicine 
University of Maryland 



Policy — The Bulletin of the School of Medicine University of 
Maryland contains scientific articles of general clinical interest, orig- 
inal scientific research in medical or related fields, reviews, editorials, 
and book reviews. A special section is devoted to news of Alumni of 
the School of Medicine, University of Maryland. 

Manuscripts — All manuscripts for publication, news items, books and 
monographs for review, and correspondence relating to editorial policy 
should be addressed to Dr. John A. Wagner, Editor, Bulletin of 
the School of Medicine, University of Maryland, 31 S. Greene 
Street, Baltimore 1, Md. Manuscripts should be typewritten double 
spaced and accompanied by a bibliography conforming to the style estab- 
lished by the American Medical Association Cumulative Index Mcdicus. 
For example, the reference to an article should appear in the following 
order : author, title, name of journal, volume number, pages included, 
and date. Reference to books should appear as follows : author, title, 
edition, pages, publisher, and date published. A reasonable number of 
illustrations will be furnished free. 

Reprints — At the time the galley proof is returned to the author, the 
publisher will insert an order form for reprints which are purchased 
directly from the publisher. Any delay in the return of this order form 
may result in considerable additional expense in obtaining reprints. 

Alumni Association News — The Bulletin publishes as a separate 
section, items concerning the University of Maryland Alumni and their 
Association. Members and friends are urged to contribute news items 
which should be sent to Dr. John A. Wagner, Editor, Bulletin of 
the School of Medicine, University of Maryland, 31 S. Greene 
Street, Baltimore, Md. 21201. 

Subscriptions — The Bulletin is issued 4 times a year. Its subscrip- 
tion price per annum, post paid is $3.00 ; single copies, $.75, when avail- 
able. Active members of the Medical Alumni Association receive the 
Bulletin in connection with the payment of annual membership dues. 
Non-Alumni subscriptions should be made payable to the University 
of Maryland and remitted through the office of Miss Jan K. Walker, 
Managing Editor. 

Advertising — The Bulletin accepts a limited number of advertise- 
ments. Rates may be obtained upon application to Miss Jan K. Walker, 
Managing Editor, Davidge Hall, School of Medicine, 522 W. Lombard 
St., Baltimore, Md. 21201. 



i 54.-5319? 



BULLETIN School of Medicine 
University of Maryland 



VOLUME 56 



JANUARY, 1971 



NUMBER 1 



Community Mental Health 

FACT and FANCY 

A Hypothetical Interview 

EUGENE B. BRODY, M.D.* 



The term, "community mental health," 
is heard everywhere these days. Just what 
does it mean? 

This term refers first to a system of 
mental health services. Such services in- 
clude the diagnosis and treatment of peo- 
ple who have identifiable emotional or 
mental disabilities, i.e., those who can be 
labelled as "patients." 

Second, the term refers to the mental 
health of the community, itself — the na- 
ture of the social system rather than of 
the individuals who make it up. There are 
problems in defining a "community" and 
measuring its "health." However, consid- 
erable research has been done in this field 
and many people do regard the mentally 
and emotionally ill, at least in part, as 
casualties of the social system. They be- 
lieve, therefore, that the most effective 
mass prevention of such illness or dis- 



* Professor and Chairman, Dept. of Ps>'chiatry, 
Director, Institute of Psychiatry and Human Behavior. 
University of Maryland School of Medicine, Baltimore 
Campus. 



ability will require changes in the society 
or community. 

This has been a source of conflict with- 
in the staffs of some urban mental health 
centers. Some have felt that more time 
and energy should be devoted to changing 
the presumed casualty-producing aspects 
of society. Others, more oriented to ill- 
ness, such as psychiatrically trained phy- 
sicians, have been inclined to emphasize 
service to those already defined as patients 
or potential patients. This may be because 
psychiatrists see mental disturbances 
among the well-to-do and educated as well 
as the poor and deprived, and are not so 
ready to attribute most such suffering to 
social ills. It is a particular issue now be- 
cause the main thrust of community men- 
tal health programs is toward the poor. 

Even within the National Institute of 
Mental Health, which provides initial 
funding for most programs, there have 
been persistent policy differences in this 
respect. At the top echelon talk has been 
largely of prevention and social change. 



January, 1971 



At the bottom level of regional adminis- 
trators, who actually inspect programs, 
the emphasis has been mainly on the pro- 
vision of conventional services to pre- 
viously deprived populations. 

What makes community mental 
health treatment services different 
from other psychiatric services? 

At the very end of the delivery system 
nothing is basically different. There are 
still a help-seeker and a helper, whether 
the encounter is individually or in groups. 
The helper does his job by talking or list- 
ening or by administering drugs or some 
other physical treatment. All of the forms 
of individual, group and family psycho- 
therapy, milieu therapy in the hospital, 
counselling of various kinds, social work 
assistance and so on, may be found in 
any large psychiatric center whether or 
not it carries a "community" label. It is 
also important to remember that while 
we know a great deal about reducing dis- 
ability, we still do not know the basic 
causes of the major mental health ill- 
nesses. It is these, such as schizophrenia, 
which make up the bulk of the hos- 
pitalized population, and there exists no 
definitive easily applied treatment for 
them. 

The major distinguishing feature of 
community mental health services, then, 
is less a matter of treatment than of or- 
ganization. This is neither unique nor his- 
torically new. The idea of a service for 
geographically defined "catchment area," 
for example, is a basic feature of the 
health systems of several European coun- 
tries. In a city such as Baltimore with a 
mobile inner city population it may not 
be so easy as in more stable societies to 
adhere strictly to the patient's address as 
means of determining his eligibility for 
services. 

Another aspect of organization is the 
availability as part of a single system, of 



a spectrum of services. The components 
of this spectrum, defined by the National 
Institute of Mental Health, are inpatient, 
outpatient, partial hospitalization, emer- 
gencies, consultation, and education. 
Again this spectrum has been present for 
years in most large departments of psy- 
chiatry. However, it is hoped that in the 
community centers the linkage of a range 
of services will make it possible to main- 
tain continuity of care, with the patient 
seeing the same helper or team of thera- 
pists, whether he is cared for on an ambu- 
latory, outpatient basis or within the hos- 
pital. 

Accessibility Is Important 

The third aspect is physical and psy- 
chological accessibility. The idea of treat- 
ing a patient close to home so that he 
doesn't break his ties with family and 
neighborhood, rather than sending him 
away to the hospital on the edge of town, 
is an important part of the community 
concept. I believe that the idea is right 
and look forward to the day when patients 
will come in and out of psychiatric units 
just as general hospitals. I also like the 
idea of rapid crisis intervention in the 
home, itself — a method successfully used 
by Dr. Querido in Amsterdam. On the 
other hand, until more definitive treat- 
ments for major disorders are discovered, 
there will always be those who will re- 
quire a prolonged period of rehabilitation 
in a setting removed from that in which 
their troubles began. Furthermore, many 
who come into psychiatric units with acute 
disturbances, such as delirium tremens 
for example, are drifters and social iso- 
lates without families or similar ties. Re- 
habilitation for them is often a matter of 
building from the ground up and the 
stable community of a relatively isolated 
institution could in the long run be more 
supportive than the atmosphere of a rapid 
turn-over city-based hospital. 



Volume 56, No. 1 



Psychological accessibility also involves 
a special aspect of providing mental health 
services for the poor and socially ex- 
cluded. Here I refer to the use of people 
who can speak the "language" of the 
neighborhoods and who are able in their 
counselling to recognize the social and 
economic contributions to emotional dis- 
orders. Such neighborhood counselors or 
health aides have been trained and em- 
ployed by a number of programs. They 
have been immensely useful, but centers 
such as that at the Lincoln Hospital in the 
Bronx where studies have been made also 
report significant difficulties. For example, 
their identification with local socioeco- 
nomic problems and their need to be 
part of the general upward thrust of pre- 
viously deprived groups sometimes makes 
it difficult for them to recognize signs of 
severe mental illness and they often tend 
to attribute them to immediate circum- 
stances. Also their close relationships 
with others in the neighborhood may 
make it difficult for them to be objective; 
conversely, it has sometimes inhibited 
people who might know them or their 
families, so they haven't been able to talk 
so freely to them as to a more highly 
trained stranger. 

How does prevention fit into the 
community mental health concept? 

This is potentially the most exciting 
feature of the community concept but its 
implementation is the most difficult. Pre- 
vention has been divided into three cate- 
gories. So-called tertiary or third-level 
prevention refers to nothing more than 
adequate treatment aimed at the preven- 
tion of disability. This, while very im- 
portant, is a part of all medical or psychi- 
atric services. Secondary prevention 
brings us closer to the community idea. 
This refers mainly to early case-finding. 
For every person identified as psychotic, 
for example, there are probably several 



managing to survive outside the treatment 
network. For many it is probably just as 
well since we can't change them anyway. 
Others, however, may be found before 
their illness has progressed too far. Many 
of these can be helped to lead more satis- 
fying and productive lives, and above all, 
their impact on their families may be 
reduced. This is one way of reducing the 
social transmission of mental illness. So 
case-finding or outreach activities may be 
aimed at locating people with a variety 
of disorders who are afraid of seeking 
help, or are ignorant of resources, or don't 
know that they are sick. One problem is 
that case-finding, which can be done by 
relatively unskilled personnel, can swamp 
existing facilities and outrun the supply 
of highly trained therapists. In other 
words, added case-finding without added 
facilities may be less than useful. 

Identify Potential Cases 

Consultation to the courts, the police, 
the schools and other institutions can 
identify potentially disturbed people early 
and help initiate remedial programs. Sev- 
eral members of our faculty, for example, 
work with the courts and are often able 
to prevent inappropriate legal dispositions 
of psychiatrically sick off'enders. Psychi- 
atrists and psychologists in our children's 
division have worked for several years 
with selected public schools in the inner 
city area. Consultation with teachers and 
others who function as surrogate parents 
may strengthen the process of healthy so- 
cialization and thus have primary pre- 
ventive value. 

Primary prevention, clearly, means 
avoiding the development of sick or mal- 
adaptive ways of thinking, feeling and 
acting in the first place. Perhaps the most 
fundamental aspects of primary preven- 
tion of psychiatric disturbance are really 
not tasks of mental health workers at all. 
They involve, for example, ensuring re- 



January, 1971 



sponsible parenthood. The limitation of 
children to loving and healthy parents 
who want and are able to care for them 
would probably do more to reduce the 
incidence of mental illness than any other 
measure I can imagine. 

This leads us to the broader issues of 
primary prevention, all of which involve 
society as a whole rather than the health 
or mental health professions in particular. 
For example, it has been estimated that 
almost 20 per cent of those in large public 
mental institutions throughout the coun- 
try are there because of defects associated 
with events during their mother's preg- 
nancies, the birth process or their first 
months of extra-uterine life. These defects 
are the consequences of malnutrition, in- 
fections, other illness and trauma. At first 
glance one thinks that the remedies are in 
the hands of obstetricians and pediatric- 
ians. These health problems, however, are 
significantly associated with poverty, ig- 
norance and lack of basic resources. 
Should the health worker then devote his 
energies to attacking the problems of 
poverty? 

Gender Identity Critical 

As another example, it is well estab- 
lished that the achievement of an ade- 
quate gender identity, i.e. as a male or 
female, requires an available role model 
in the person of the parent of the same 
sex. The failure of such identity-forma- 
tion appears to have particularly severe 
consequences, promoting vulnerability to 
a variety of psychiatric problems, in boys. 
The absence of a self-confident economi- 
cally adequate father as a role model has 
in the past been frequently noted in the 
poorer strata of the black community. 
This has, to an important degree, been a 
consequence of racial discrimination mak- 
ing it impossible for men to obtain ade- 
quate education and jobs. Should the 
mental health worker, then, fight against 



discrimination as part of his preventive 
job? 

There is some reason to believe that 
social powerlessness while not causing 
major mental illness does promote feel- 
ings of hopelessness, despair, lack of 
initiative, feelings of futility about long- 
range planning, and vulnerability to self- 
narcotizing behavior. Should mental 
health workers spend time to help open 
channels of communications between the 
people their clinics are to serve and city 
hall? Should they become involved in 
struggles against expressways which 
threaten dislocation? Should they help 
tenants' groups fight against retaliatory 
eviction by landlords? 

These are illustrations of the dilemmas 
posed to community mental health pro- 
grams by the challenge of preventive pub- 
lic health oriented psychiatry. These di- 
lemmas will not be easily solved, and 
they are important contributors to the 
turbulence which has been characteristic 
of such centers as they have been develop- 
ing in urban centers throughout the na- 
tion. It seems likely, on one hand, that 
health workers who are visible to their 
clients as allies in the struggle for a better 
life will be more psychologically accessi- 
ble to them as counsellors and therapists. 
Experiences of successful self-determina- 
tion and autonomy can certainly do much 
for personality growth and development. 
On the other hand, the concomitant tend- 
ency to politicize all health activities can 
easily result in blindness to our ignorance 
about basic causes of illness and malfunc- 
tion, and neglect of the large mass of 
patients whose already existing psychi- 
atric problems will remain fundamentally 
untouched by social-preventive activities. 

Pros and Cons 

So, there is something to be said on 
both sides and program directors will 
have to decide where to place their major 



Volume 56, A'O. 1 



efforts. My own feeling is that the com- 
munity mental health staff should docu- 
ment, whenever possible, the role of pre- 
ventable social problems in producing psy- 
chiatric disability. It should be prepared 
to offer consultation to community lead- 
ers and agencies in remedying these con- 
ditions. Even more, members of the staff 
may well assist groups in achieving their 
social goals, and certainly the center staff 
should be clearly identified as on the side 
of the community in its efforts toward 
self-development and freedom of oppor- 
tunity. On the other hand I don't think 
that the energies of highly trained pro- 
fessionals should be diverted to this goal 
any more than the job of doctors who 
identified the mosquito as the malarial 
vector was to clear the swamps. Their so- 
cial responsibility was to alert govern- 
ments and communities to the importance 
of swamp clearing, and to insist that it 
be carried out — but not to stop their pri- 
mary tasks to do it themselves. 




Dr. Eugene B. Brody 

January, 1971 



One unfortunate consequence of inap- 
propriate politicization can be the alien- 
ation of highly trained professional peo- 
ple who prefer to confine their work to 
their areas of technical competence and 
whose contributions are essential if any 
health program is to be worthy of the 
name. This last factor also becomes im- 
portant because the outreach, social ac- 
tion, and simpler counselling activities of 
a program require the development of less 
educated "paramedical" workers. These 
people in programs throughout the coun- 
try have wanted a greater share of the 
decision-making power, and more control 
over policy and administration. They have 
had particular leverage since they usually 
come from the communities the programs 
are designed to serve, and thus regard 
themselves as representing the commu- 
nity. The fact that others in the "catch- 
ment area" don't agree and that local jur- 
isdictional disputes then arise further 
complicates the problem of administration 
and direction. These and related issues 
have turned community health and men- 
tal health programs into political football 
in several large cities. 

What is the role of a university de- 
partment of psychiatry in com- 
munity mental health programs? 

The traditional social role of the uni- 
versity medical center has been the long- 
range one: the production of professional 
manpower without which health services 
cannot be maintained, and the produc- 
tion of new knowledge without which they 
will be ineffective. The pursuit of these 
goals constitutes the most fundamental 
kind of service; they are basic to every- 
thing else. Another way of saying it is 
that research is the imaginative form of 
compassion. But it isn't so easy to sepa- 
rate research and education from direct 
clinical care. Society needs doctors, 
nurses, social workers and others who 



know and are interested in the community 
and in the problems of the city. If a uni- 
versity is to place its students and resi- 
dents in a community mental health pro- 
gram it must be able to ensure the pro- 
fessional adequacy of that program. It 
cannot do so without a measure of influ- 
ence on the administration and particu- 
larly on the recruitment and employment 
of senior professional people. There is 
also a mutuality here. The community 
program in this era of a seller's market 
cannot hope to attract adequate profes- 
sional staff without the attraction of the 
university association. It cannot operate 
extensive services without the participa- 
tion of students of medicine, social work, 
psychology and nursing, and without the 
assistance of residents in psychiatry. 



All of these considerations mean that 
new and imaginative patterns of collab- 
oration between states (responsible for 
providing service and disbursing tax funds 
for the purpose) and university medical 
centers will have to be evolved. Premature 
crystallization or polarization of opinion 
on either side can impair the orderly evo- 
lution of a system which will provide op- 
timum care at the same time that it pro- 
vides a setting for the training of much 
needed helping personnel. They mean, 
also, that the collaborative pattern must 
include a mechanism for participation by 
community representatives. In this way 
the health programs will remain ps^ho- 
logically accessible to the people they are 
designed to serve, and responsive to their 
changing needs. 




GROWS NEARER COMPLETION— A maze of steel fabrication forms the North Hos- 
pital building in mid-December as it approaches completion. University Hospital can be 
seen adjacent to the construction which has a decorative fence painted by local artists 
to enhance the beauty of the construction area. 



Volume 56, No. 1 



Managing Editor Named 



The Editorial Board of the Bulletin has 
announced the appointment of Miss Jan 
Katherine Walker as Managing Editor 
effective January 1, 1971. 

A native of Jacksonville, Fla., and an 
alumna of Florida State University, Miss 
Walker is a professional editor, coming to 
the University of Maryland from the 
American National Red Cross where she 
served as an Information Specialist writer 
in the Office of Public Relations. Miss 
Walker has also had considerable experi- 
ence in newspaper work including having 
served three years as a staff writer with 
the Associated Press in Atlanta, Ga., and 
Birmingham, Ala. 



Her academic career is distinguished 
by her membership in Theta Sigma Phi, 
a professional society for women in 
journalism and communications, in Phi 
Alpha Theta, national honorary society 
for students of history, and the American 
Alumni Council. Miss Walker's current 
interests will be in assisting the Editorial 
Board in further improving the quality of 
the Bulletin and assisting the Editor in 
broadening its influence in behalf of fac- 
ulty and school. 

Miss Walker will serve in a fulltime 
capacity with offices in Davidge Hall, 
School of Medicine, 522 W. Lombard. 



Dean Names Committee 



In an effort to improve communication 
with the people who live near University 
Hospital, many of whom depend on the 
hospital as their primary source of medi- 
cal care. Dean John H. Moxley, III, has 
formed a Community Advisory Com- 
mittee. 

In announcing the formation of the 
committee. Dr. Moxley, who will act as 
chairman of the group, explained that the 
Medical School is in the process of re- 
viewing many of its programs, including 
service programs that directly afl'ect neigh- 
borhood people. 

"We are reorganizing our ambulatory 
services, including our emergency depart- 
ment, in anticipation of the greatly en- 
larged facilities that will be available for 
this purpose when the new North Hospital 
Building is completed in late 1972," he 
said. "We need to exchange ideas with 
the community about this reorganization. 



And, there are many local problems that 
can be solved much more easily through a 
joint committee of the Medical School and 
the community — safety, traffic, job train- 
ing and recruitment, for example. I feel 
sure that this committee can exert a very 
considerable influence in improving the 
quality of life in this community." 

Other members of the committee in- 
clude: 

Thomas Seaborn, assistant director 
and community relations director of the 
West Baltimore Civic Association; mem- 
ber of the executive committee of the 
Safety First Club of Maryland, and or- 
ganizer and director of the West Side 
Community Club. 

Myrtle McCullers, acting chairman 
of the Neighborhood Advisory Council 
for the Inner City Community and Mental 
Health Program. The council acts as a 
group of consultants for the program in 



January, 1971 



BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND 



decisions on new locations for mental 
health centers in the city, choice of new 
staff members, and issues involving inno- 
vations in delivery of mental health care. 

Yusuf Karrieam, community or- 
ganizer for the Foresight Community 
Council, a Model Cities field office. 

Father Thomas J. Donnellan, ad- 
ministrator of St. Peter the Apostle 
Church. 

Dr. Eugene B. Brody, professor and 
chairman of the department of psychiatry, 



University of Maryland School of Medi- 
cine, and director of The Psychiatric In- 
stitute. 

Dr. William Spicer, Jr., associate 
dean for health care programs. University 
of Maryland School of Medicine. 

Dr. George H. Yeager, director, Uni- 
versity of Maryland Hospital. 

Dr. J. Tyson Tildon, research assist- 
ant professor in pediatrics and assistant 
professor in biochemistry. University of 
Maryland School of Medicine. 



Dermatology Wins Award 



Dr. Harry M. Robinson, head of the 
division of dermatology, has received the 
American Academy of Dermatology's 
Gold Award for Excellence in Teaching 
and Research. 

The award, citing Dr. Robinson for his 
pioneering efforts in dermatological re- 
habilitation, was presented at the acad- 
emy's recent annual meeting where the 
division's exhibit won top honors. Dr. 
Robinson was assisted in preparing the 
exhibit by Dr. Carolyn J. Pass and 
Dr. Emanuel H. Silverstein. 

Dr. Robinson and his staff are con- 
cerned in rehabilitating what he calls 
"dermatological cripples" — people who 
are incapacitated for work by skin dis- 
orders ranging from acne to cancer. 

Two years ago, Dr. Robinson estab- 



lished the nation's first clinic designed to 
rehabilitate workers who were out of jobs 
because of skin disorders. 

"We have helped dropouts return to 
school and helped young adults who had 
given up hope of returning to work," he 
said. "We have rehabilitated 82 per cent 
of the patients our unit accepted for care. 
Not only were their skin disorders allevi- 
ated, but they are now economically inde- 
pendent." 

A result of his research is an index of 
dermatological disability which takes into 
account evaluations of a dermatologist, 
vocational counselor, social worker and 
psychologist and standardizes terms used 
to describe degrees of disability. It is also 
helpful in predicting the rehabilitation po- 
tential of the patient. 



10 



Vflhimc 56, No. 1 




MEDICAL SCHOOL SECTION 



'Dean 



s 

Im^LETTER 



Dear Alumni and Friends of the Medical School: 



The University of Maryland, like many other educational in- 
stitutions, is undergoing significant change. These changes 
stem in great part from the unprecedented growth experienced 
by higher education in our country in the past decade or two. 
How to continue to grow without completely destroying the interpersonal re- 
lationships involved in the educational process is one of the major challenges 
of the day. The universities' attempts to seek a solution has led them to de- 
velop programs centered around a series of decentralized campuses — -in Col- 
lege Park, Catonsville, Princess Anne and Baltimore. Each campus will be 
directed by a Chancellor with the Office of the President as an over-all um- 
brella agency coordinating the growth and development of the total university. 
Dr. Albin O. Kuhn, who has been the Chancellor at Catonsville and Balti- 
more, will be moving to the Baltimore Campus fulltime in the near future. 
The new organization augurs well for the medical center in that for the first 
time there will be a fulltime chancellor to supervise and coordinate the many 
activities of this professional school campus and to provide an on-going inter- 
face with developments throughout the university. 

It is unfortunate that at this time of great change Dr. William Long (Class 
of 1937) has for personal reasons found it necessary to resign from the Board 
of Regents. Dr. Long, who was chairman of the Regents Baltimore Campus 
Committee, was an advocate of and catalyst for growth and development here 
in Baltimore. Further, as a loyal graduate of the Medical School he has been 
of enormous help to the school and to me personally. I have on several oc- 
casions discussed medical school matters with Dr. Long and have always 
benefitted by his thoughtful and sage advice. Whoever is chosen to succeed 
him will have very large shoes to fill. All of us here wish him well in the 
future and extend to him a heartfelt thank-you for all that he has done. 

With best wishes, 

Sincerely yours. 




'John H. Moxley, M.D. 
Dean 



January, 1971 



BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND 



Adolescent Medicine Division 




Dr. Heald 



Adolescents have unique problems, but 
one usually not brought to light is that 
adolescence is the time when many seri- 
ous diseases develop. 

Dr. Felix P. Heald, Director of the 
new division of adolescent medicine at 
the School of Medi- 
cine, reports psycho- 
social and develop- 
mental problems are 
common, but less rec- 
ognized problems of 
hypertension, othero- 
sclerosis, and obesity 
also begin to appear 
during the teenage years. Addiction to 
tobacco, alcohol, and drugs has become 
increasingly common during middle to 
late teens. 

"The need for specialized physicians in 
adolescent medicine is becoming more 
and more important." he relates. "Teen- 
agers are shuffled from ward to ward in 
medical centers. Sometimes he is cared for 
by the department of pediatrics, other 
times he's treated in adult wards. Pedi- 
atricians or other physicians tend to han- 
dle the adolescent in a mother-child re- 
lationship, directing discussion to the 
mother as if the child weren't present. 
Privacy is needed in order to create an 
atmosphere of confidence and trust. The 
physical examination must be thorough, 
yet sensitive — especially for the adoles- 
cent girl." 

With the appointment of Dr. Heald, 
Maryland became the sixth institution in 
the United States to conduct training and 
research in adolescent medicine. Univer- 
sity Hospital's new north wing, now under 
construction, will devote its eighth floor 



to this specialty. 

The whole idea of adolescent medicine 
is a young one. In the past few years, 
however, more and more people are be- 
coming interested in the field. Dr. Heald 
says that there are already a number of 
pediatricians who limit their practices to 
the adolescent. 

Dr. Heald was the first to train in ado- 
lescent medicine, having received his 
training at the Children's Hospital in Bos- 
ton. He established a department of ado- 
lescent medicine at the Children's Hos- 
pital in Washington. D.C., and has taught 
pediatrics at Harvard Medical School. 
Georgetown University School of Medi- 
cine, and most recently at George Wash- 
ington University. Prior to his move to 
Baltimore, he was professor and chair- 
man of the department of pediatrics at 
George Washington University and pedi- 
atrician-in-chief at the Children's Hospital 
in Washington, D.C. 

He is president of the Society of Ado- 
lescent Medicine, participated in the 
White House Conference on Nutrition in 
1969, and is a member of the Joint Com- 
mission on Mental Health for Children, 
Inc., Task Force III, the Society for Pedi- 
atric Research, and the American Pedi- 
atric Society. His name appears on more 
than 70 scientific publications. 

"If you took a group of eight-year-old 
children," Dr. Heald says, "shaved their 
heads, removed all of their clothing, and 
lined them up with their backs to you; 
you couldn't distinguish between male 
and female. If you took the same group 
ten years later, I'll bet you can tell the 
difference. That's what adolescent medi- 
cine is all about." 



Volume 56, No. 1 



MEDICAL SCHOOL SECTION 



Dr. Trump Heads Pathology 



Dr. Benjamin F. Trump, formerly Pro- 
fessor of Pathology, Duke University 
Medical Center, Durham, N. C, has been 
appointed Professor and Head, Depart- 
men of Pathology. 

Prior to his September 1970 Maryland 
School of Medicine appointment, he had 
been a professor of pathology at Duke 
since 1967. He replaces Dr. Robert 
Schultz, professor of Pathology, who be- 
came acting head when Dr. Harlan Firm- 
inger stepped down as department head 
on July 1, 1967. 




Dr. Benjamin Trump 

The pathologist has a balanced interest 
in patient care, teaching and research. 
Concurrent with his other duties. Dr. 



Trump will assume administrative and 
professional responsibility for operations 
of Hospital Clinical Laboratories. 

"We are delighted to have Dr. Benja- 
min Trump join the School of Medicine 
faculty. He brings to Maryland a distin- 
guished career as an investigator as well 
as a deep understanding of the teaching 
and service functions of a department of 
pathology," said Dean John H. Moxley, 
III. 

"His presence, and the staff that he is 
recruiting to the University, will provide 
us with a balanced effort in pathology. 
This type of balance becomes increasingly 
important when one views the department 
of pathology as the primary bridge be- 
tween the teaching and investigative thrust 
of the preclinical departments dealing pri- 
marily with the cell and subcellular struc- 
tures, and the efforts of the clinical de- 
partments in the application of principles 
of pathophysiology to the disease process. 
It is in the area of pathology that these 
two types of efforts must be interdigi- 
tated," he added. 

Dr. Trump said, "The primary goal of 
the Department of Pathology is the under- 
taking of human disease with emphasis 
on mechanisms and changes occurring at 
the subcellular level and in molecular 
terms. An all around approach to the 
study of pathology, the department cor- 
relates gross and clinical pathology with 
changes at the molecular level. The scope 
of training ranges from forensic pathology 
and toxicology to modem diversified 
training in clinical pathology, anatomic 
pathology, neuropathology, surgical path- 
ology and experimental pathology," out- 
lined the new department head. 



Januarx, 1971 



BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND 



Teaching Aspect Excellent 

He continued, "The teaching aspect of 
the department here is excellent. I hope 
to augment existing programs through 
new ideas broadening both the areas of 
clinical and experimental pathology." 

Dr. Trump will also be director of re- 
search for the Shock Trauma Center. 

"Our program at the Trauma Center 
makes possible the study of human dis- 
eases at autopsy with modern techniqv.es. 
In this program we'll be dealing with cell 
injury as it relates to shock," he added. 

Other areas in which greater investiga- 
tions will be forthcoming are those of en- 
vironmental pathology to study the effects 
of chemical agents such as industrial tox- 
ins, pollutants and pesticides on mem- 
brane structures and in marine pathology. 
In marine pathobiology studies are con- 
ducted to determine the role of environ- 
mental toxins on marine animal systems. 
Several marine animal systems provide 
important models for study of cellular re- 
actions to injury. 

A native of Kansas City, Mo., Dr. 
Trump received his B.A. degree from the 
University of Missouri and his M.D. from 
the University of Kansas School of Medi- 
cine. His internship in pathology was at 
the University of Kansas Medical Center, 
1957-58; he was a resident-fellow. De- 
partment of Pathology, University of 



Kansas Medical Center, 1958-59; a re- 
search associate in Anatomy, University 
of Washington School of Medicine, 
Seattle, Washington, 1959-60. and a 
trainee in experimental pathology, Uni- 
versity of Washington School of Medicine, 
1960-61. 

His first academic appointment was 
1961-63 when he was named as an in- 
vestigator in experimental pathology. Of- 
fice of the Scientific Director, Armed 
Forces Institute of Pathology, Washing- 
ton, D. C; from 1963-65 he was As- 
sistant Professor of Pathology, University 
of Washington School of Medicine, and 
in 1965 he joined the staflf of Duke Uni- 
versity Medical Center as an Associate 
Professor of Pathology. 

Dr. Trump served in the Medical Corps, 
United States Army Reserve, 1958-64, 
and was on active duty from August 15, 
1961 to August 12, 1963, Armed Forces 
Institute of Pathology. 

He is a member of the American As- 
sociation for the Advancement of Science; 
the Electron Microscope Society of 
America; the International Academy of 
Pathology; the Histochemical Society; 
American Association of Pathologists and 
Bacteriologists; American Society of Ex- 
perimental Pathology; American Associa- 
tion of University Professors; American 
Society for Cell Biology; and the Ameri- 
can Society of Microbiology. 



Volume 56, No. 1 





The Maryland Obstetrical and Gyneco- 
logical Society has elected Dr. Umberto 
VillaSanta, associate professor of ob- 
stetrics and gynecol- 
ogy, as president for 
1971. 

Others elected were: 
Dr. James P. Durkin, 
assistant professor of 
m^^^-'-'^jl^ obstetrics and gynecol- 

W^r iA ogy> !*•*• Jerome Glow- 

Dr. VillaSanta acki, director of ob- 
tetrics and gynecology at Franklin Square 
Hospital; delegate-at-large, Dr. Albert H. 
Dudley, Jr., assistant in gynecology and ob- 
stetrics at The Johns Hopkins School of 
Medicine. 



Goldstein Named 
to Editorial Board 

Dr. Robert O. Goldstein, a Baltimore uro- 
logist and parttime teacher at University 
Hospital, has been named to the editorial 
board of the Bulletin by the Board of Direc- 
tors of the Medical Alumni Association. 

Dr. Goldstein fills the alumni representa- 
tive quota on the alumni publication's board. 
He is very active in alumni affairs as a mem- 
ber of the medical alumni association, the 
Baltimore Alumni Association of the Uni- 
versity of Maryland, and as a representative 
to the University of Maryland Alumni Gen- 
eral Council. 



Dr. Edward F. Cotter Is Honored 

Dr. Edward F. Cotter, associate professor 
of medicine, has been honored at a testi- 
monial dinner by the Department of Medi- 
cine in recognition of his special contribu- 
tions to the medical school and the De- 
partment. 

"Through his efforts the educational pro- 
gram at the Maryland General Hospital was 
reorganized and developed," said Dr. Theo- 
dore E. Woodward, head of the Department 
of Medicine. "He deserves the lion's share 
of credit for growth of the affiliations in in- 
ternal medicine between our respective hos- 
pitals." 




Dr. Cotter 

Dr. Cotter, who recently retired as Head 
of the Division of Introduction to Medicine 
(Physical Diagnosis) for sophomore medi- 
cal students, received a University of Mary- 
land chair with an inscribed plate which 
read: 

"Edward F. Cotter, M.D., F.A.C.P.: 
From Friends And Associates Who Know 
Him As A Wise Physician And Humble 
Gentleman. In Recognition Of His Excel- 
lent Record As Chief Medical Resident 
1939-40, A Distinguished Career As 
Practitioner And Leadership In Teaching 
Of Physical Diagnosis." 



January, 1971 



BULLETIN OF THE SCHOOL OF MEDDICINE, UNIVERSITY OF MARYLAND 



A member of the Class of 1935, he is 
among Dr. T. Nelson Cary, Dr. William 
Love and others who have been honored by 
the Department at an academic dinner for 
senior faculty and staff members. 

Dr. Raiti Heads Hormone 
Research Agency 

Dr. Salvatore Raiti of London, England, 
has recently become director of the Na- 
tional Pituitary Agency, based at the School 
of Medicine. 

Funded by the National Institute of Arth- 
ritis and Metabolic Diseases, the agency each 
year collects about 80,000 human pituitary 
glands from which it prepares growth hor- 
mone for distribution to investigators 
throughout the country for clinical research 
on certain kinds of dwarfism in children. 




Dr. Haiti 

"The growth hormone extracted from one 
pituitary gland, a pea-sized gland at the base 
of the brain, is only enough for treatment 
of one individual for three or four days," 
Dr. Raiti explained. "It takes many glands 
to determine the growth pattern and metabo- 
lism in one patient. With more than 10,000 
children suffering from hypopituitary dwarf- 



ism and many more who have other types of 
dwarfism, much more growth hormone is 
needed, and so investigators are searching 
for ways to synthesize it." 

He added, "In the Department of Pedi- 
atrics, we are studying dwarfism and com- 
paring the effectiveness of different forms of 
therapy. But there are many more problems 
to be studied. For example, why are some 
children small from the time of birth? Is 
this owing to hormone deficiency or to nu- 
tritional problems during pregnancy? Would 
such babies benefit from growth hormone 
given during the first year of life? Would 
babies of diabetic mothers benefit from 
growth hormone given early in life?" 

In discussing other hormonal problems of 
childhood. Dr. Raiti said, "We do not know 
why the normal time of puberty is after the 
tenth year. Understanding the mechanism of 
puberty might lead to more effective treat- 
ment for very early or very late puberty." 

Another endocrinologist who recently 
joined Dr. Raiti's staff, Dr. Fima Lifshitz, 
is participating in these studies. 

"We see from 15 to 20 children a week 
with such hormonal problems as hypopitui- 
tary dwarfism, thyroid and adrenal disorders, 
abnormal puberty, and diabetes mellitus. 
Since many of the basic problems in pedi- 
atrics can be answered only in the labor- 
atory, research techniques for measure- 
ments of hormones and other body con- 
stituents are being set up." 

The new NPA director is an associate pro- 
fessor and director of pediatric endocrinol- 
ogy in the School of Medicine and at Uni- 
versity Hospital. He received his medical de- 
gree at the University of Queensland, Aus- 
tralia, and trained in pediatrics in Australia, 
Edinburgh and London. 

In 1963, he was a fellow in the steroid 
training program at the Worchester Founda- 
tion, Shrewsbury, Mass. From 1964-67 he 
was a fellow in pediatric endocrinology at 
the Johns Hopkins Hospital and School of 
Medicine. He then returned to England as 
senior lecturer and consultant endocrinolo- 
gist at London University's Institute of Child 
Health and the Hospital for Sick Children. 



Volume 56, No. 1 



MEDICAL SCHOOL SECTION 



Accreditation Granted 

The continuing education program of 
the University of Maryland School of 
Medicine has been granted full accredita- 
tion by the American Medical Associa- 
tion's Council on Medical Education. 

In a letter received by the Dean, the 
Council stated: "In the annual listing 
'Continuing Education Courses for Physi- 
cians,' which will appear in the August 2, 
1971, issue of the Journal of the Ameri- 
can Medical Association, courses of the 
University of Maryland School of Medi- 
cine will be specifically designated as 
courses offered by an accredited institu- 
tion." 

The Council will periodically review all 
accredited institutions, probably at three 
or four year intervals once the accredita- 
tion program has been fully implemented. 



Ophthalmology Receives Funds 

The Department of Ophthalmology has 
received an unrestricted grant of $5,000 
from Research to Prevent Blindness, Inc., 
to support and accelerate intensive studies 
of the eye and its diseases. 

"The unrestricted nature of the gr^nt 
permits our investigators to pursue new 
ideas for which other funds are not avail- 
able," said Dr. R. D. Richards, head of 
the department. 

The University of Maryland has re- 
ceived $10,000 in unrestricted grants 
from RPB over the past two years. Na- 
tionwide RPB has made grants amounting 
to more than $1.5 at 43 medical schools 
and has channeled more than $16 million 
into construction of modern eye research 
centers. 



You, foo. Can Receive 
the BULLETIN Postpaid! 

The Bulletin is published four times a year, jointly by the 
Faculty of the School of Medicine of the University of Mary- 
land and the Medical Alumni Association. Active members 
of the Medical Alumni Association receive the Bulletin 
upon the payment of annual membership dues which include 
the yeady subscription fee of the Bulletin. 

All members of the Faculty who are not members of the 
Medical Alumni Association and other friends of the Medical 
School are invited to subscribe to the Bulletin. The sub- 
scription fee is $3.00 per annum, postpaid. Make check pay- 
able to the University of Maryland and mail it to 

MISS JAN K. WALKER 

522 W. LOMBARD ST. 

BALTIMORE, MD. 21201 



January, 1971 



The U.ofM. Medical Alumni 
SALUTE 





Dr. Margaret B. Ballard of Union, West 
Virginia, doctor and historian, is now well 
into her second career and recently received 
the C. Samuel Kistler Travel Award in rec- 
ognition of her "outstanding contributions" 
to the West Virginia travel industry. 

At the presentation of the award, Gov. 
Arch A. Moore of West Virginia spoke of 
Dr. Ballard's great love and affection for 
the state and her energy and enthusiasm in 
promoting the state. The award is given an- 
nually to an individual or group making out- 
standing contributions to the state's travel 
industry. 

"For the first time in more than 70 years, 
I'm speechless," said the University of Mary- 
land School of Medicine graduate upon ac- 
cepting the award at the Governor's Con- 
ference on Travel. 

Following graduation in 1926, Dr. Ballard 
completed residency in Obstetrics and Gyne- 
cology and for many years taught her spe- 
cialty at the School of Medicine. One of 



her outstanding contributions was her con- 
tinued interest and enthusiasm for the con- 
troversial planned parenthood movement. 
She has lived to see her ideas and efforts 
take form of a now accepted facet of mod- 
ern society. 

Because of her profound and continuing 
interest in history, Dr. Ballard became the 
author of an important volume on the his- 
tory of the University of Maryland which is 
entitled "A University Is Born" published 
in 1965. 

Shortly after her book was published "Dr. 
Maggie" retired from active practice de- 
voting her interest and energy to historical 
research and to the promoting of the many 
interesting aspects of her home state. 

The School of Medicine and its Alumni 
Association are happy to recognize Dr. Bal- 
lard's continuing academic interest and 
achievement, and extends herewith its salute 
and congratulations on a continuing active 
and non-academic career. 




Exhibit Illustrating Pioneering Efforts in Dermatological Rehabilitation Wins Award 

i Volume 56, No. 1 




ALUMNI ASSOCIATION SECTION 



President's Letter 



OFFICERS 



President 

Theodore Kardash, M.D. 

President-EIect 

f:DWARD F. Cotter, M.D. 

Vice-Presidents 

Irving Burka, M.D. 
John C. Hamrick, M.D. 
He.njamin M. Stein, M.D. 

Secretary 

Robert B. Goldstein, M.D. 

Treasurer 

Arlie R. Mansberger, M.D. 

Executive Director 

William H. Triplett, M.D. 

Executive Administrator 

Francis W. O'Brien 

Executive Secretary 

Louise P. Girkin 

Members of Board 

Martin E. Strobel, M.D. 
Henry H. Startzman, Jr., M.D. 
Kyle Y. Swisher, Jr., M.D. 
William J. R. Dunseath, M.D. 
William H. Mosberg, Jr., M.D. 
Charles E. Shaw, M.D. 
Joan Raskin, M.D. 
Donald T. Lewers, M.D. 
Cliff Ratliff, M.D. 



Dear Fellow Alumni: 

In the past there have been many problems in connection 
with the publication of the Bulletin. By the employment of 
fulltime people we hope that we can give better service to all 
who receive the Bulletin. I welcome any suggestions or com- 
ments on how we can improve this publication. I would like 
to make one suggestion and that is to encourage sending to 
the Alumni Office your biographical sketch. 

I consider it of importance to inform you that the School 
of Medicine and the Medical Alumni Association are working 
closely together to improve the future publication of the 
Bulletin. Recently a Managing Editor was hired on a fulltime 
basis as the first step toward looking at what changes should 
be considered. The Managing Editor will have a small staff 
and all indications are that future Bulletins will be sent to 
you early in each quarter of the year. 

The response to the Davidge Hall Restoration Fund Drive 
is encouraging and I suggest to those Alumni who have not 
had the opportunity to contribute to consider doing so over 
the period of five years that we plan to run this Fund drive. 
I wish to thank those who have already contributed to the 
Fund and who have made pledges for the years to come. 



Sincerely, 



Ex-officio Members 
Board of Directors 

Lewis P. Gundry, M.D. 

Wilfred H. Townshend, Jr., M.D. 

John H. Moxley, III, M.D. 




Theodore Kardash, M.D. 
President 



January, 1971 



(^lass 



NOTES 



Your achievements, fellow alumnus, are 
of interest to your classmates. They consti- 
tute a reward to the faculty, are a challenge 
to the younger physicians, and are an item 
of prestige for the University. Please cooper- 
ate with us by forwarding news of yourself 
or any alumnus to the Bulletin. Thank you. 

CLASS OF 1929 

Dr. Jacob H. Conn, assistant professor 
emeritus of psychiatry at Johns Hopkins 
University Medical School, has received the 
Gold Medal Award for his contributions to 
Scientific Hypnosis. 

The 1929 University of Maryland Medi- 
cal School graduate was a fellow in psychia- 
try at the Phipps Clinic, Johns Hopkins Hos- 
pital (1931-33) and was in charge of sex 
research at the Children's Psychiatric Serv- 
ice from 1937-40. He was the first practicing 
psychiatrist in Maryland to be certified in 
1935 by the American Board of Psychiatry 
and Neurology. 

He was acting chief medical officer of the 
Supreme Bench of Baltimore, past president 
of the Maryland Association of Private 
Practicing Psychiatrists, consultants to the 
United States District Court Public Health 
Service and the Veterans Administration. 

Dr. Conn was the recipient of the 1960 
award for the best clinical contribution to 
scientific hypnosis, the 1961 Raginsky 
Bronze Plaque, the 1964 Schneck Award, 
the 1966 S.C.E.H. Presidential Award, and 



the 1968 award for the best paper in clinical 
hypnosis. 

His latest recognition came at the Society 
for Clinical and Experimental Hypnosis 
22nd annual meeting. 

CLASS OF 1936 
Dr. Benjamin H. Issacs has announced the 
change of his office address from 1261 E. 
Belyedere Avenue in Baltimore to Mercy 
Hospital, 301 St. Paul Place, for the prac- 
tice of Otolaryngology. He is currently serv- 
ing as the president of the Maryland Ear, 
Nose and Throat Society. 

CLASS OF 1952 
Dr. Robert A. Douglas closed his Home- 
stead, Fla., office in May 1970 and went to 
Belgium for training to be a Medical Mis- 
sionary in Africa. He is expected to be out 
of the country for at least four years. 

CLASS OF 1965 
Dr. Sanford Levin, 15141 Middlegate Rd., 
Silver Spring, Md., recently discharged from 
the Army where he was a pediatrician at the 
United States Military Academy and hos- 
pital commander at Stewart Air Force Base, 
has joined a pediatric corporation in Laurel, 
Md. 

He has been appointed as clinical instruc- 
tor in pediatrics at George Washington 
Medical School and has staff privileges at 
Children's Hospital in Washington and Holy 
Cross Hospital of Silver Spring. 



Volume 56. No. 1 



Beatl)S 



Dr, Irving J. Cohen, 62, former executive 
vice president of the Maimonides Medical 
Center, Brooklyn, N.Y., and assistant chief 
medical director for planning at the Veter- 
ans Administration, died October 29, 1970. 

Dr. Cohen, a native of Brooklyn, received 
his M.D. degree in 1930 from the University 
of Maryland Medical School. Following in- 
ternship in pediatrics at Massachusetts Gen- 
eral Hospital in Boston, he served as assist- 
ant resident in pediatrics at Children's Hos- 
pital, Philadelphia; as pediatrics resident at 
Beth-El Hospital, and then as executive 
physician at the Brooklyn Hebrew Orphan- 
age. 

During WW II he was in the Army Medi- 
cal Corps, and after the war became an as- 
sistant clinical director at the VA hospital in 
the Bronx. In 1952 he became manager of 
the VA hospital in Baltimore and two years 
later became deputy director of all VA hos- 
pitals. 

From 1959 until he resigned from the post 
in 1962, he served as the assistant VA chief 
medical director of planning. His leadership 
in medical care for the chronically ill earned 
him high commendation. 

In 1962 he joined Maimonides as execu- 
tive vice president, which under his adminis- 
tration, became internationally known. Its 
community mental health center was one of 
the first in the nation. 

He retired from Maimonides in 1969. 
However, he still served as consultant to the 
Maimonides VA, and the Department of 
Health, Education and Welfare until his 
death. 



He was graduated from Oilman School .in 
1953, attended Lehigh University and re- 
ceived his M.D. degree in 1962 from the 
University of Maryland School of Medicine. 

Dr. Carozza was known for his work and 
research in infectious medicine. He did ex- 
tensive research into the way certain bac- 
terial toxins influence the defense systems of 
the body and how the body resists such in- 
fluences. 

Early in his career. Dr. Carozza served as 
a fellow in international medicine for the 
University of Maryland in Lahore, Pakistan. 
Another academic pursuit was the study of 
the history of medicine. He was a fellow of 
the Institute for the History of Medicine at 
the Johns Hopkins medical school and was 
instrumental in organizing a Society for the 
History of Medicine at the University of 
Maryland medical school. 



Dr. John A. Buchness, a Catonsville, Md., 
physician, died November 18, 1970 at age 
78. 

Dr. Buchness, a specialist in Industrial 
Medicine and Surgery, was graduated from 
the University of Maryland Medical School 
in 1919. He attended Loyola High School 
and Loyola College and was later active in 
the Alumni Associations of both schools. 

In addition to his medical practice. Dr. 
Buchness was a noted Philatelist, winning 
several honors for his collection of Lithu- 
anian stamps. He was a 50-year member of 
both the Medical and Chirugical Faculty of 
Maryland and the American Legion. 



Dr. Frank A. Carozza, Jr., assistant pro- 
fessor of medicine at University of Mary- 
land Medical School and head of the Di- 
vision of Physical Diagnosis, died October 
30, 1970 at age 35. 



Dr. William Wallace Walker, a general sur- 
geon who practiced for more than 45 years 
in Baltimore hospitals, died December 2, 
1970 at age 72. 



January, 1971 



BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND 



A graduate of the University of Mary- 
land Medical School, he began his practice 
in Baltimore in 1923. His internship was at 
Mercy and University Hospitals and he later 
practiced at Franklin Square, North Charles, 
Maryland General, Bon Secours and Luther- 
an Hospitals. 

He also served as an associate professor 
of surgical anatomy at the University of 
Maryland Medical School. 

CLASS OF 1898 BMC 
Dr. Arthur M. Loope, 217 Sherbourne Rd., 
Syracuse, N.Y., died June 26, 1970 at age 
94. He is survived by a daughter, Mrs. Jor- 
dan A. Zimmerman. 

CLASS OF 1903 P&S 
Dr. C. Melvin Coon, Star Route, Milan, 
Pa., died April 1970 at age 94. 

CLASS OF 1903 
Dr. George S. M. Kiefifer, 1010 Leeds Ave., 
Baltimore, Md., died July 1970. 

CLASS OF 1908 
Dr. Frederick Snyder, 44 Clinton Ave., 
Kingston, N.Y., died February 24, 1970 at 
age 88. 

CLASS OF 1908 P&S 
Dr. George Davis, 28 S. Church Street, 
Waynesboro, Pa., died recently. 

Dr. Oscar T. Barber, 145 Temple St., Fre- 
donia, N.Y., died August 26, 1970. 

CLASS OF 1909 
Dr. Clarence Irving Benson, Box 123, Port 
Deposit, Md., died September 2, 1970. 

CLASS OF 1912 P&S 
Dr. Leonard O. Schwartz, 3421 Pennsyl- 
vania Ave., Weirton, W. Va., died in June 
1970 at age 83. 

CLASS OF 1912 BMC 
Dr. William T. Rumage, Sr., 171 Vose 
Ave., South Orange, N.J., died April 25, 
1970 at age 83. He is survived by his wife. 



CLASS OF 1912 
Dr. Dawson Orme George died December 
21, 1970. 

CLASS OF 1914 
Dr. Lowrie W. Blake, 5609 7th Ave. Dr. 
West, Bradenton, Fla., died September 10, 
1970. 

CLASS OF 1917 
Dr. Milton Cumin, 130 Slade Ave., Apt. 
306, Baltimore, Md., died recently. 

CLASS OF 1918 
Dr. Thomas C. Speake, 211 Lynhurst Dr., 
Ormond Beach, Fla., died October 9, 1970 
at age 77. 

CLASS OF 1919 
Dr. C. Wilbur Stewart, 6 East Read St., 
Baltimore, Md., died October 16, 1970 at 
age 74. 

CLASS OF 1923 
Dr. Joseph M. Gutowski, 433 Brace Ave., 
Perth Amboy, N.J., died July 28, 1970. 

CLASS OF 1925 
Dr. Cecil M. Hall, 608 Strain Building, 
Great Falls, Mont., died in November, 1970. 

Dr. Morris Albert Jacobs, 1010 North 
Point Rd., Baltimore, Md., died September 
20, 1970. 

CLASS OF 1926 

Dr. Henry DeVincentis, 285 Henry St., 
Orange, N.J., died in September 1970. 

Dr. Harry Anker, 4445 Coldbath Ave., 
Sherman Oaks, Calif., has died at age 66. 

CLASS OF 1927 
Dr. Herbert Reifschneider, Chestertown, 

Md., died November 28, 1970. 

CLASS OF 1929 
Dr. Fred L. DeBarbieri, 4723 Park Heights 
Ave., Baltimore, Md., died January 12, 1970 
at age 70. 

(Cont'd, on page xiv) 



Volume 56, No. 1 



ALUMNI NEWS REPOUT 



TO THE BULLETIN: 



I would like to report the following: 



SUGGESTIONS FOR NEWS ITEMS 

American Board Certification 
Change of Address 
Change of Office 
Residency Appointment 
Research Completed 
News of Another Alumnus 
Academic Appointment 
Interesting Historic Photographs 



January, 1971 



Name. 



Address- 



Class- 



Send to 



Dr. John A. Wagner, Editor 
Bulletin — School of Medicine 
University of Maryland 
31 S. Greene St. 
Baltimore, Md. 21201 



BULLETIN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND 



CLASS OF 1932 
Dr. Maxwell Herman Shack, Patton State 
Hospital, Patton, Calif., died recently. 

CLASS OF 1934 
Dr. Nathan Rudo, Mt. Zion Hospital Medi- 
cal Center. San Francisco, Calif., died Au- 
gust 29, 1970. 

CLASS OF 1935 

Dr. Gerard P. Hammill, Vanadium Road, 
Pittsburgh, Pa., died October 21, 197C. 

Dr. J. B. Anderson, 12 West Wing, Doc- 
tors Bldg., Asheville, N.C., died August 7, 
1970. 

CLASS OF 1936 

Dr. Joseph E. Bush, 117 S. Main St., 
Hampstead, Md., died October 25, 1970. 

Dr. Saul Karpel, 190 Montauk Ave., New 
London, Conn., died July 2, 1970 at age 60. 



CLASS OF 1937 

Dr. Robert F. Cooney, 512 Lackawanna 
Ave., Mayfield, Pa., died July 16, 1970. 

Dr. Thomas D'Amico, 208 Passaic Ave., 
Passiac, N.J., died recently. 

CLASS OF 1943 
Dr. William Henry Pomeroy, 1852 Po- 
quonock Ave., Poquonock, Conn., died Oc- 
tober 5, 1970. 

CLASS OF 1944 
Dr. David T. Rees, 702 Montgomery Ave., 
Cumberland, Md., died April 8, 1970. 

CLASS OF 1946 
Dr. Clemmer M. Peck, 480 Monterey Ave., 
Los Gatos, Calif., died in September 1970. 

CLASS OF 1951 
Dr. Guy Reeser, Jr., St. Michaels, Md., 
died October 1, 1970 at age 47. 



Support 

Davidge Hall 
Restoration 

Fund 



Send Contributions To: 

Alumni Association 
Room 102, Davidge Hall 
University of Maryland 
School of Medicine 
Baltimore, Maryland 21201 



Volume 56, No. 1 




TAYLOR MANOR HOSPITAL 

For Psychiatric Diagnosis and Treatment 



IRVING J. TAYLOR, M.D. 
MEDICAL DIRECTOR 



ELLICOTT CITY, MD. 
PHONE: HO 5-3322 



COMPETENT EXPERIENCED SURGICAL FITTERS IN ATTENDANCE 
EQUIPMENT AND SUPPLIES FOR THE f 1 

HOSPITAL PHYSICIAN 

LABORATORY SURGEON 
INDUSTRY NURSING HOME 

SERVING THE MEDICAL PROFESSION FOR ALMOST HALF A CENTURY 

MURRAY- BAUMGARTNER 

SURGICAL INSTRUMENT CO., INC. 




2501 eWYNNS FALLS PARKWAY 
BALTIMORE, MARYLAND 21216 



AREA CODE 301. 
Telephone: 669-9300 



The 

John D. Lucas Printing Co. 

26th & SissoN Streets 

Baltimore, Maryland 21211 

Phones: BElmont 5-8600-01-02 



Symbols in a life of 
psychic tension 

M.A. 

class of '66 

Ph.D. 

thesis ... in progress 

G.i. 

series and complete 
examination normal 

(persistent indigestion) 



Valium^ 

(diazepam) 

2-mg, 5-mg, 10-mg tablets 
t.i.d. and h.s. 

for relief of psychic 

tension and resultant 

somatic symptoms 

within the first day 

for some patients 



Before prescribing, please consult 
complete product information, a 
summary of which follows: 
Indications: Tension and anxiety 
states; somatic complaints which are 
concomitants of emotional factors; 
psychoneurotic states manifested by 
tension, anxiety, apprehension, 
fatigue, depressive symptoms or 
agitation; acute agitation, tremor, 
delirium tremens and hallucinosis 
due to acute alcohol withdrawal; ad- 
junctively in skeletal muscle spasm 
due to reflex spasm to local pathol- 
ogy, spasticity caused by upper 
motor neuron disorders, athetosis, 
stiff-man syndrome, convulsive 
disorders (not for sole therapy). 
Contraindicated: Known hypersensi- 
tivity to the drug. Children under 6 
months of age. Acute narrow angle 
glaucoma. 

Warnings: Not of value in psychotic 
patients. Caution against hazardous 
occupations requiring complete 
mental alertness. When used ad- 
junctively in convulsive disorders, 




possibility of increase in frequency 
and/or severity of grand mal seizures 
may require increased dosage of 
standard anticonvulsant medication; 
abrupt withdrawal may be associated 
with temporary increase in frequency 
and/ or severity of seizures. Advise 
against simultaneous ingestion of 
alcohol and other CNS depressants. 
Withdrawal symptoms have occurred 
following abrupt discontinuance. 
Keep addiction-prone individuals 
under careful surveillance because of 
their predisposition to habituation 
and dependence. In pregnancy, lac- 
tation or women of childbearing age, 
weigh potential benefit against pos- 
sible hazard. 

Precautions: If combined with other 
psychotropics or anticonvulsants, 
consider carefully pharmacology of 
agents employed. Usual precautions 
indicated in patients severely de- 
pressed, or with latent depression, 
or with suicidal tendencies. Observe 
usual precautions in impaired renal 
or hepatic function. Limit dosage to 



smallest effective amount in elderly 
and debilitated to preclude ataxia or 
oversedation. 

Side Effects: Drowsiness, confusion, 
diplopia, hypotension, changes in 
libido, nausea, fatigue, depression, 
dysarthria, jaundice, skin rash, 
ataxia, constipation, headache, in- 
continence, changes in salivation, 
slurred speech, tremor, vertigo, 
urinary retention, blurred vision. 
Paradoxical reactions such as acute 
hyperexcited states, anxiety, halluci- 
nations, increased muscle spasticity, 
insomnia, rage, sleep disturbances, 
stimulation, have been reported; 
should these occur, discontinue 
drug. Isolated reports of neutropenia, 
jaundice; periodic blood counts and 
liver function tests advisable during 
long-term therapy. 



{^ 



Roche 

LABORATORIES 
Division of Holtmann-La Roche Inc. 
Nutley, New Jersey 07110 



April, 1971 VOLUME 56 • number 2 



PUBLISHED FOUR TIMES A YEAR 
JANUARY, APRIL, JULY AND OCTOBER 



JOINTLY BY THE FACULTY OF THE 



AND THE MEDICAL ALUMNI ASSOCIATION 



Second class mailing privilege authorized at Baltimore, Maryland 



Volume 56 

Number 2 

APRIL, 1971 



BULLETIN School of Medicine 

University of Maryland 



JOHN A. WAGNER, B.S., M.D. 

Chi«( Editor 



JAN K. WALKER 

Managing Editor 

EDITORIAL BOARD 
Edward F. Coffer, M.D. 

George Entwisle, B.S., M.D. 

Robert B. Goldstein, M.D. 

John C. Krantz. Jr.. Sc. D., Ph. D. 

Arlie Mansberger. M.D. 

William H. Mosberg. B.S., M.D. 

Francis W. O'Brien 



John H. Moxley. III. M.D. 
(ex-officio) 



Theodore Kardash, M.D. 
(ei- officio) 



i 



Policy — The Bulletin of the School of Medicine University of 
Maryland contains scientific articles of general clinical interest, orig- 
inal scientific research in medical or related fields, reviews, editorials, 
and book reviews. A special section is devoted to news of Alumni of 
the School of Medicine, University of Maryland. 

Manuscripts — All manuscripts for publication, news items, books and 
monographs for review, and correspondence relating to editorial policy 
should be addressed to Dr. John A. Wagner, Editor, Bulletin of 
the School of Medicine, University of Maryland, 31 S. Greene 
Street, Baltimore 1, Md. Manuscripts should be typewritten double 
spaced and accompanied by a bibliography conforming to the style estab- 
lished by the American Medical Association Cumulative Index Medicus. 
For example, the reference to an article should appear in the following 
order : author, title, name of journal, volume number, pages included, 
and date. Reference to books should appear as follows : author, title, 
edition, pages, publisher, and date published. A reasonable number of 
illustrations will be furnished free. 

Reprints — At the time the galley proof is returned to the author, the 
publisher will insert an order form for reprints which are purchased 
directly from the publisher. Any delay in the return of this order form 
may result in considerable additional expense in obtaining reprints. 

Alumni Association News — The Bulletin publishes as a separate 
section, items concerning the University of Maryland Alumni and their 
Association. Members and friends are urged to contribute news items 
which should be sent to Dr. John A. Wagner, Editor, Bulletin of 
the School of Medicine, University of Maryland, 31 S. Greene 
Street, Baltimore, Md. 21201. 

Subscriptions — The Bulletin is issued 4 times a year. Its subscrip- 
tion price per annum, post paid is $3.00 ; single copies, $.75, when avail- 
able. Active members of the Medical Alumni Association receive the 
Bulletin in connection with the payment of annual membership dues. 
Non-Alumni subscriptions should be made payable to the University 
of Maryland and remitted through the office of Miss Jan K. Walker, 
Managing Editor. 

Advertising — The Bulletin accepts a limited number of advertise- 
ments. Rates may be obtained upon application to Miss Jan K. Walker, 
Managing Editor, Davidge Hall, School of Medicine, 522 W. Lombard 
St., Baltimore, Md. 21201. 



BULLETIN School of Medicine 
University of Maryland 

VOLUME 56 APRIL, 1971 NUMBER 2 



TABLE OF CONTENTS 

Alumni Day 1971 12 

Only One Door— The Community Pediatric Center 13 

Teenage Mothers 21 

Profile . . . Humanitarian, Physician, Mother 24 

Ramsay Named 28 

Ambulatory Nursing 32 

The Electrodiagnosis of Neuromuscular Disease 33 

Frank Kemble, M.D., M.R.C.P. 

Dean's Letter ■ 

Faculty Appointments and Promotions '• 

President's Letter '" 

Fifty Year Graduates '^ 

Alumni Day Class Captains '^ 

Deaths v 



April, 1971 11 



ALUMNI DAY 

THURSDAY, JUNE 3, 1971 

MEDICAL ALUMNI ASSOCIATION 



MORNING PROGRAM 

9:30 a.m. Registration - Coffee Davidge Hall 

10:00 a.m. Opening of Alumni Day Chemical Hall 

Report to Alumni 

John H. Moxley III, M.D. 

Dean, School of Medicine 

Theodore Kardash, M.D. 

President, Medical Alumni Association, Presiding 

10:30 a.m. 

Assistant Dean's presentation to Alumni on student selection admission policies 
and changes in the School of Medicine curriculum 

11:30 a.m. 

Presentation to Alumni on Davidge Hall Restoration Plan 

12:00 noon 

Annual Alumni business meeting and presentation of 
Alumni Gold Key Honor Award 



1:00 p.m. Alumni Complimentary Luncheon Psychiatric Institute 

Gymnasium 
5 th Floor 



EVENING PROGRAM 

6:00 p.m. Lord Baltimore Hotel 

Reception for 50 Year Graduates 

and Graduating Class of 1971 

7:00 p.m. Annual Alumni Banquet Lord Baltimore Hotel 

Ballroom 



12 Volume 56, No. 2 




Not long ago in the Inner City, a 
mother who wanted to get complete 
medical services for her sick child might 
have had to pass through the doorways 
of five or ten different clinics and wait 
a couple of hours in each. 

Today for many mothers the only door 
necessary is the single one leading into 
the University of Maryland Community 
Pediatric Center, located in an old textile 
office building at 412 West Redwood 
Street. 

And, indeed the center belongs to the 



Only 



One 



Door 



The Community 
Pediatric Center 



children. 

"Our charge by legislation is to provide 
health care to a designated population 
from zero to their nineteenth birthday. 
Since we are with the University it is also 
within the spirit and desire of legislation 
that we look at new ways to offer com- 
prehensive care in a more effective, more 
efficient way. As an euphemism ... to 
have new ways to do more things 
efficiently for the same or less cost," said 
Dr. George A. Lentz, Director of the 
center. 



April, 1971 



13 



"In the early days we used to talk 
about the three 'Cs' that went along with 
our charge and operation — continuity, 
comprehensivity and community. In other 
words, continuing comprehensive health 
care to a designated community. And, 
this also implies community participation 
in the program," explained John Gleason, 
CPC administrator. 

Last year approximately 10,000 chil- 
dren were registered for care at the center. 
The area served is bounded by Mulberry 
Street, Greene, Pratt and Sharp Streets, 
down to Howard to Middle Branch and 
then to Gwynns Falls, around Carroll 
Park to Carey Street, across Baltimore 
Street to Fremont Avenue and finally 
north to Mulberry. 

Prior to the existence of the CPC the 
children in the adjacent area had to go 
from one doctor to another, from one 
clinic to another if their families wanted 
to secure sound medical services. Treat- 
ment occurred by symptom with little 
regard for the child as a person. 

ELIGIBILITY 

"In addition to the geographic eligi- 
bility, the family's income must fall with- 
in certain economic levels," stated Mr. 
Gleason. "The division between pre- 
ventive and comprehensive care is often 
subtle, but when the child reaches a point 
where prevention and diagnosis cease 
and treatment begins, in order to be 
eligible for treatment they must fall 
within the levels set by the Baltimore City 
Health Department. 

The income levels apply to four clinics 
that operate with the cooperation of the 
Baltimore City Health Department. Other 
community pediatric clinics are operated 
by the Greater Baltimore Medical Center, 
Sinai Hospital, and Baltimore City 
Hospitals. The income eligibility levels 
were set at the beginning of the project 



and in spite of cost of living increases 
have not been changed. 

"A family of two which would be a 
mother and a child, in our case, must 
fall within an income level of $1,800 and 
it goes up so that a family of ten — a 
mother, father and eight children or 
whatever combination — should fall with- 
in an income level of $6,500 a year," 
said Mr. Gleason. 

Is there any possibility of eliminating 
the income requirement? 

"We'd like to see this income criteria 
for eligibility eliminated, just saying that 
anyone who lives within the area is 
eligible. Our observations of what happens 
here and who comes here indicate that 
the difference between prevention and 
treatment for those who don't fall within 
the economic levels would not be so great 
that we couldn't take care of them," Mr. 
Gleason explained. 




14 



Volume 56, No. 2 



How does the center distinguish be- 
tween preventive and comprehensive care? 

"The way we distinguish between the 
two is what we refer to as child health 
supervision which is ongoing supervision 
of the well child — periodic checkups, 
plus inoculations — preventive care of 
that sort and diagnosis. But where pre- 
vention and diagnosis cease and actual 
treatment of a diagnosed complaint be- 
gins we still carry the responsibility for 
referring that child to a source of help 
that can treat the child. This care is 
paid for by Medicaid, insurance or the 
family," said Mr. Gleason. 

PROBLEMS CREATED 

"Economic requirements create too 
many problems," said Dr. Lentz. "It 
forces the decision making process on the 
person at the reception desk as to whether 
the person according to his eligibility 
is to be treated , . . and before long you 
begin to spHt hairs. You make mothers 
angry . . . you only need to make one 
or two people angry a day over techni- 
calities and you destroy your purpose. She 
may be over the income limit, but be- 
cause of great extenuating circumstances 
that really don't become apparent, such 
as social problems, everything else . . . 
well one's hands are tied. Then you get 
into the business 'We can see your child 
if he has an illness type of problem,' in 
other words, if she comes with a problem 
we can take care of it on an emergency 
walk-in situation but we can't help if he's 
not ill. And, we can't follow the child in 
a longitudinal care program." 

Mr. Gleason added, "Just on the score 
that you never turn away a sick child you 
can handle it in the emergency walk-in 
situation ... for an acute illness; but then 
if you adhere to this income scale thing 
maybe you can't take care of that child 
on a long-term basis." 



CARE PROVIDED 

There are three levels of service at the 
center. 

Emergency Walk-In: Total emergency 
care is provided for those who come into 
the center. If the child has a runny nose, 
fever, convulsions . . . this area is like 
a regular outpatient department. 

Health Supervision and Total Pre- 
ventive Care: Youngsters have a sched- 
uled visit planned for the second, third, 
fourth, sixth and ninth months the first 
year, twice the second, and yearly there- 
after. During the visits the child re- 
ceives health supervision including 
physical measurements such as height and 
weight which are compared against a 
standard growth curve chart. The parent 
during these visits routinely sees the nu- 
tritionist, and there also is a standard 
program for them to see a dentist at 
particular times in the whole health care 
plan. 

Another part is a blood or hemoglobin 
screening for anemia and a quick psycho- 
logical test, the Denver Developmental 
test, is given by the nurse. The nurse 
does the interviewing, looking at any 
problems that the mother has, putting 
them all together and then calling a doctor 
for consultation. Immunizations are also 
given in this phase. 

Extra Diagnostic Services: Should a 
special problem be detected in either of 
the first two areas, the child is referred 
to a speciality clinic. Among the clinics 
at the center are allergy and ophthal- 
mology and in some instances the child 
may be referred to a regular clinic at the 
University. However, a number of the 
CPC staff physicians have special talents, 
special skills and they take it upon them- 
selves to man the speciality clinics and 
follow up the kids in chronic care situa- 
tions. 



April, 1971 



15 




"The kids for instance who have 
muscular skeletal disabilities and so forth 
are sent to me," said Dr. Lentz, "and I 
usually consult or see them. If a youngster 
has behavioral problems, Dr. McCaffrey 
sees those; we have an adolescent program 
where we follow teenage pregnancies and 
we're in the process of evolving a drug 
clinic. Again, serving the population in 
our area." 

CPC STAFF 

The center, which opened its doors in 
1967, is staffed by about 85 professionals 
including physicians, nurses, dentists, 
social workers, nutritionists and psycho- 
logists, psychiatrists, radiologists, ophthal- 
mologists, obstetricians, gynecologists, 
cardiologists and orthopedists. Some are 
fulltime, others parttime on a retainer 
per clinic basis. 

In addition to Dr. Lentz, the center is 
administered by Dr. Ray Hepner, director 
of research, and Dr. Prasanna Nair, di- 
rector of education. The center operates 
under the Department of Pediatrics 
headed by Dr. Marvin Cornblath. 

Is there any volunteer work at the 
CPC? 



"There are volunteers from the com- 
munity — The Citizens Council. Ifs a 
very active Citizens Council that has been 
developed slowly and has been playing 
an important role. We're looking more 
and more to them to help us define and 
to help us know what they see as needs 
in the community in which we are called 
upon to serve. These are mothers from 
our population," said Dr. Lentz. 

CENTER UNIQUE 

One uniqueness of the center is the 
nursing staff. 

"Most centers have as their nursing 
staff, clinic nurses who are indigenous to 
the unit," stressed Dr. Lentz. "We are 
among the few who have public health 
nurses who are by training 'the family 
practitioner of nursing or family advo- 
cate.' " 

Each of the nurses is assigned to a 
certain census tract and they go when 
possible, when needed and regularly to 
visit the homes in their area. They are 
on a first name basis with these families 
and know the problems of the grand- 
mother, the brother, the father — the entire 
home situation. Two days a week Nurse 
"A" is in the field visiting her assigned 
census tract and then two days a week 
she's in the clinic when children from 
her area are scheduled for child health 
supervision appointments. 

"Another thing that takes place here, 
too, is that when those children from a 
given census tract come in for their 
health supervision appointments, the 
Baltimore City Health Department Public 
Health nurse who is assigned to that 
census tract is usually here to be with the 
families as is our PH nurse," added Mr. 
Gleason. 

The Baltimore City Health Department 
nurse has responsibility for all members 
of the family not just the children. The 



16 



Volume 56, No. 2 



duties of the two often overlap but also 
are well coordinated. 

"For instance if Mrs. Jones, the patient 
and her family have a problem and our 
nurse detects this in talking with the 
mother or notices something herself dur- 
ing her home visits, our nurse will call 
her city nurse colleague and tell her 
about the problem and find out what 
she can do about it or she'll seek consul- 
tation with someone at the CPC," said 
Dr. Lentz. 

He continued, "Many times I'll suggest 
to the nurse that they (the family) might 
contact a certain doctor or clinic or that 
she ask the social worker where Mrs. 
Jones can get what she needs. The nurse 




will either relate that to Mrs. Jones 
directly or to the Baltimore City nurse. 
This is not by accident, but by design and 
there is constant conferencing between 
these nurses. This is why I say our center 
has a uniqueness to its services." 

All of the centers working with the 
Baltimore City Health Department have 
relationships which make them different. 

CPC ROLE 

"Ours is affiliated with the University 
of Maryland School of Medicine and the 
University Health Sciences Campus so 
that we have an added role — the responsi- 
bility of education in addition to service. 
Medical, Dental, Nursing and Social 



Work students are able to take part and 
observe the operation. So, our program 
here is not just service alone. Research 
is a smaller part of the overall, total 
effort of the people here," said the CPC 
director. 

Mr. Gleason explained that "the edu- 
cation and research are based upon the 
service in that educationally the center is 
an effort to provide an exemplary instance 
of health care for the student and the 
house staff." 

The research is also service related 
because it is directed to evaluating the 
service being provided at the CPC. Multi- 
phasic screening that is undertaken in 
five area schools provides data on cardiac 
examinations, vision testing and blood 
testing for anemia. 

"One means of determining the center's 
effectiveness — just a piece in measuring 
the total effectiveness — can be shown 
through a program in which it was dis- 
covered one quarter of the boys in one 
school had anemia. We're not saying it 
was our operation alone but at least the 
input was used to educate the responsible 
authorities about the need for adequate 
school lunch programs. Now the number 
of anemia cases is down to about eight 
per cent. So, the collection of data, 
which is a research tool, documented 
proof of the problem and resulted in our 
staff being able to help in alleviating the 
problem. That's a small piece in the total 
impact on the community." 

INNER CITY YOUTH 

Inner City youth are plagued not only 
by the difficulties of growing up in a con- 
fused world, but also by an almost un- 
believable excess of disease and dislo- 
cation over surburban counterparts. And. 
hospitals are filled with children from 
these areas suffering from such illnesses 
as diarrhea dehydration or old-fashioned 



April, 1971 



17 



pneumonia which are "totally anachron- 
istic." 

"We're doing widescale evaluation of 
hospitalization rates trying to compare 
our service population with a similar 
population that doesn't have our services. 
As for dislocations, it is not uncommon 
that we see dislocated families. The in- 
come levels are very low and many times 
there is only one parent at home. We find 
the young girl going to school and the 
grandmother caring for the child. This is a 
social type situation," related Dr. Lentz. 

A large percentage of the beds in 
pediatric wards throughout the city are 
filled with children from the Inner City. 




"It's safe to say you won't see as many 
kids from our census tracts or our re- 
sponsible area in hospitals as you would 
from other similar areas that don't have 
our services. Because if the youngster 
comes here with diarrhea or it's the very 



beginning of diarrhea or a cold there's 
no limitation to his coming back for treat- 
ment," explained the CPC head. 

"I saw a youngster today and have 
seen him every day for the past five days. 
He's a small baby and had diarrhea but 
we were able to keep on top and follow- 
up through our Public Health nurse. So 
there's no question we prevented an ad- 
mission. Ordinarily he might not have 
been taken to a doctor until maybe the 
third day of the illness," said Dr. Lentz. 

REDUCE ADMISSIONS 

For the quarter ending December 31, 
1970 with almost 1,500 visits at the 
center, only 39 cases were hospital ad- 
missions. This is about 12 persons out of 
500 and many of those were emergency 
walk-in cases who hadn't been seen 
previously. 

"I definitely think we have had an im- 
pact on hospitalization. Dr. Stine. head 
of program evaluation, is looking at this 
in more concrete terms. What we're talk- 
ing about here are subjective observations 
and impressions, however, which are 
pretty reliable," said Dr. Lentz. 

"We have very close supervision of 
health care problems and one of the 
things is that the youngster doesn't have 
to go back to a regular outpatient clinic, 
hospital clinic etc. where it's busy and 
he must wait and have the burden of the 
expense," pointed out the CPC director. 
"So many different kinds of things can 
be handled right here under one roof. 
There's no shuffling them about from 
clinic to clinic and from location to lo- 
cation." 

Last year statistics show that there 
were 67.000 contacts between patients 
and professional staff. In other words, dur- 
ing approximately 25,000 patient visits 
(not individuals but patients coming for 
treatment) there were 67,000 professional 



18 



Volume 56, No. 2 



contacts. Each child that came to the 
center on the average saw a doctor, nu- 
tritionist, social worker and psychologist. 




CPC GOALS 

Dr. Ray Hepner, director of the CPC 
when it was established, once stated the 
center's goals as striving "to make contact 
with children in the area and assure that 
they receive the preventive and curative 
services needed, not to duplicate or to 
replace any existing services, but to assure 
through coordination that the objective — 
a better coming generation than the last 
one — is achieved." 

Some methods through which the 
center is trying to "make contact" with 
the deprived families: 

— A school heart disease screening 
program whereby heart specialists use a 
special electronic device for rapid heart 
examination. 

— The installation of computers at the 
center to make treatment and services 
easy and less time consuming. 

— Door to door visits by public health 
nurses and consultants. 

— Publication of a monthly newsletter 



to instruct people in basic health care and 
proper living. The newsletter carries 
simple, but nutritious meals and tips on 
child behavior. 

— Counseling on how to buy food at 
reasonable prices, how to prevent food 
wastage, how to use leftovers, and how 
to get the most out of the food stamp pro- 
gram. 

— Mothers are taught how to nurse 
babies properly, how to prevent home 
accidents, how to combat infant problems 
such as teething, diaper changing, etc. 

BETTER GENERATION 

In line with creating a "better coming 
generation" Dr. Lentz remarked: 

"I think that what one is talking about 
is that if you are able to improve the 
overall health of the child — lower the 
morbidity of disease, lower the absen- 
teeism in schools, and work with schools 
in evaluation of learning disabilities . . . 
in that way improving a child's health and 
helping them with their education — 
that you have an adolescent, a young 
adult who will be better off than a person 
who was sick with his chronic problems 
not cared for, who missed school and 
perhaps had problems of identification." 

Another way of putting this, said Mr. 
Glcason, is "that if we can raise the level 
of these children's physical, mental and 
emotional well-being they are that much 
better able to cope with the problems of 
growing up in the kind of environment 
they must face every day." 

"I think if we have social work to 
look at the family problems and try to 
help people with their marital problems 
and if we work with the schools to im- 
prove or work with their learning and be- 
havior, we are making efforts to assist the 
families in their family organization or 
structure. The very fact that we have 
a citizens council creates a sense of re- 



April, 1971 



19 



sponsibility or helps people help them- 
selves. If parents see that people are 
willing to help them and are available 
then there's a different outlook on the 
part of the family, and that's what you 
really change," said the director. 

"If the child is healthier and goes to 
school and you help him with his school 
problems so that he does better in school, 
then you have less problems at home. 
The family home situation is improved, 
i.e. the better chance of a youngster 
growing up in a more supportive, total- 
istic manner of being better equipped 
to meet adulthood," explained Dr. Lentz. 

CPC'S FUTURE 

What about the role of the CPC in the 
future? 

"I think that there will be an attempt 
to coordinate — and I'm in favor of it 
100 per cent — our cooperation with other 
project grants that involve maternal and 



infant programs with family practice pro- 
grams — adult programs. I see the di- 
rection as a family centered program. It 
would be my greatest desire if this unit 
were responsible and had obligations and 
responsibilities for, not just the children 
we already serve but their families. There 
is no way we can provide total health 
care for everybody but if we can improve 
the family health in the World Health 
Organization's definition of more than 
just the absence of disease but better liv- 
ing ... we can be the patient-family 
advocate with the political community," 
Dr. Lentz observed. 

"This area needs help ... we can docu- 
ment that there's lead in the houses and 
that the heat is bad, and so forth . . . 
become the family advocate to improve 
a segment of the population. A nice 
measure of success might be the re- 
duction of crime in the area," concluded 
the center's director. 




20 



Volume 56, No. 2 



v-y 




TEACHING MOTHERS— Dr. Misbah Khan, center, directs a discussion with mothers-to-be 
about contraception, sex, how to care for a baby and many other subjects during classes 
once a week at Edgar Allan Poe Schools No. 1 and No. lA. Looking on as Dr. Khan talks 
is, left, Mrs. Hargrove, teacher of family living and home economics, and, right. Dr. Cicely 
Williams, visiting professor of pediatrics, University of Maryland. 

Teenage Mothers 



Students at Edgar Allan Poe Schools 
No. 1 and No. lA study the basic three 
R's, but share a unique status requiring 
special education — a need fulfilled by 
staff and students from the University 
of Maryland School of Medicine. 

Not too long ago these girls who are 
pregnant mothers ranging in age from 12 
to 20 would not have been permitted to 
finish their basic education. Today these 
schools, a junior and senior high, are 
operated exclusively for pregnant girls 
or girls who have recently given birth. The 
schools have a total combined enroll- 
ment of approximately 3,000. 



Since the summer of 1969, the Com- 
munity Pediatrics staff as well as medical 
students have augmented the curriculum 
through once a week classes at each 
school. Every girl takes a course entitled 
"Laboratory for Effective Living" which 
is divided into three units taught by staff 
and students from the University in col- 
laboration with the school's family living 
and home economics teacher. 

"People are receiving education about 
birth prevention but the young girl who is 
already pregnant is often forgotten," said 
Dr. Misbah Khan, coordinator of pedi- 
atric ambulatory services at University 



April, 1971 



21 



Hospital. 'The main purpose of our pro- 
gram is to prevent the birth of a second 
unwanted child." 

The course's family living unit stresses 
personal, medical, and nutritional care 
during the prenatal period, care of the 
infant, and includes discussion of contra- 
ception, sex information and education. 

"These girls are very immature," re- 
marked Dr. Eric Fine, chief resident in 
Community Pediatrics. "Some girls think 
that a baby at birth comes from the navel. 
It is our desire to give these girls con- 
tinuing health education, and to help cor- 
rect any misconceptions they might have 
in regard to a variety of health related 
subjects." 

Dr. Khan explained, "Some of the 
girls, especially the junior high girls don't 
even know how they became pregnant, 
let alone what to expect during pregnancy. 
We know of one mother who told her 
daughter that you die seven times when 
you go into labor. With information like 
that, how can you expect a child to go 
through her pregnancy without great ap- 
prehension?" 

The section on family relationships 
focuses on the role of the student in the 
family structure and attempts to help the 
girl understand her responsibilities as a 
teenage mother. In a home management 
section the girl is given pointers on 
budgets and managing a home with 
emphasis on purchasing techniques and 
distribution of household responsibilities. 

Dr. Khan leads the discussions which 
cover topics suggested by the girls them- 
selves. 

"Topics range from drugs to family 
planning, jobs, money, taxes, etc.," com- 
mented Dr. Khan. "Some of the medical 
students assisted in answering questions 
regarding drugs." 

Questions for the next lecture-dis- 



cussion are submitted during the ensuing 
week. 

Following each laboratory session six 
to eight of the girls who are nearest their 
delivery dates are given tours of the 
delivery room at University Hospital and 
Maryland General Hospital. At Mary- 
land General the girls are shown slides 
by the nursing staff illustrating what 
happens in the labor room and through 
delivery. These tours are planned and 
conducted by the nursing supervisors, 
Mrs. Lois Hundertmark and Mrs. M. E. 
Messner, University Hospital, and Mrs. 
B. Thornton, Maryland General Hospital. 

"The cooperation we receive from the 
two nursing staffs makes the visits dy- 
namic and invaluable in helping the girls 
understand pregnancy. The girls become 
familiar with the delivery room area, then 
they see the nursery. This is to help re- 
move any of the girls' fears about giving 
birth," stressed Dr. Khan. 

Mrs. Vivian E. Washington, principal 
of the two schools, describes the girls as 
"eager to learn." 

Last summer, the Department of Pedi- 
atrics, through Dr. Khan's efforts, se- 
cured jobs for 14 of these young mothers 
in the hospital's pediatric department as 
Neighborhood Youth Corps workers. 

The two Baltimore schools are open 
a 10-month school year plus a six-week 
summer session for girls who want to 
make up fourth quarter work. The girls 
carry a normal school load and get 
social and medical counseling. 

A student transfers to the Poe School 
from her regular school and attends until 
she delivers, when she is out from four 
to six weeks. After her post partum 
checkup, she returns to Poe School and 
is transferred to a regular school at an ap- 
propriate time in the school year, usually 
at the end of the quarter or semester. 



22 



Volume 56, No. 2 



Those girls who Hve in a certain area 
of the city are eligible for free medical 
care from the University's Community 
Pediatric Center (CPC), until they be- 
come 19 years old. Prenatal care is ad- 
ministered by the University Hospital's 
Department of Obstetrics and Gyne- 
cology. 

At the CPC, each teenage mother-to- 
be is assigned a freshman medical student 
who serves as her patient advocate, who 
follows her through his four years of 
medical school. Dr. Prasanna Nair, as- 
sistant professor of pediatrics, is in charge 
of the program. 

The program is advantageous to both 
mother and medical student. The teenage 
mother benefits by having her patient 
advocate see that she gets proper at- 
tention and medical care when she needs 
it. The medical student is notified when 
the young mother goes into labor and 
he helps her through the traumatic shock 
of delivery. Thus, he has the opportunity 
to establish rapport with a patient in the 
first year of his medical education; most 
medical students don't have this oppor- 
tunity to work with patients so early in 
their training. The medical student also 
has a chance to become acquainted with 
the social aspects relating to his patient's 
history as well as learn to function 
effectively as a member of a team made 
up of a public health nurse, social worker 
and nutritionist. After the child is born, 
the student maintains a follow-up contact 
with the mother and the child during his 
remaining years at the University. 

Dr. Oscar Stine, associate professor of 
pediatrics, has done studies on prema- 
turity rate and frequency of death of 
infants born to girls who attended School 



No. 1 and those bom to girls who did 
not. Twelve per cent of the infants bom 
to mothers who attended school weighed 
less than five pounds while 23 per cent 
of the infants bom to the control group 
were of low birth weight. 

In one year. Dr. Stine found that there 
were 13 deaths among babies born to 
girls who did not attend the school, arid 
no deaths of babies born to mothers who 
attended Poe School. Another year 
yielded similar results, pointing up the 
importance of concern for the mothers' 
nutritional, emotional, educational and 
medical experience. Dr. Stine found that 
infant mortality was greatest for the very 
young mothers, for those from the poorest 
neighborhoods, and for those mothers 
who did not receive prenatal care. 

Dr. Stine also convenes a Council for 
Teenage Parents during which representa- 
tives from the schools of social work, 
nursing and medicine meet once every 
two months to stimulate further campus 
involvement with the problems relating 
to teenage parents. 

Dr. Khan added, "We try to give them 
facts to prevent another unwanted baby. 
This program is already too late to pre- 
vent one unwanted pregnancy. The 
challenge is to prevent another one from 
happening. We give them the facts. They 
decide their own destiny." 

The first edition of the school news- 
paper expressed the sentiments of many 
of the girls. On the cover, a stork grips 
in his beak the traditional baby bundle, 
with the words, "The Raven," printed on 
it. And, on the last page was Poe's 
refrain, 

"NEVERMORE." 



April, 1971 



23 



Profile . . . 



Humanitarian, 

Physician and 

Mother 



dt ^ 






I 



Dr. Misbah Khan 



There is no pursuit more worthwhile 
in life than man's service for another. 

"The need for the world today is man's 
humanity to man. The decade 1960-69 
was the age when men began to contem- 
plate the welfare of all human beings and 
the 70's have the opportunity to see this 
concept emerge," predicted Dr. Misbah 
Khan, Director of Community Programs 
and Assistant Professor of Pediatrics, 
shortly before returning to West Pakistan. 

She added, "The challenge is not 
technical or even scientific advancements, 
but in reaching out to the hearts of men, 
to stir that longing in every human being 
to do something good." 

Dr. Khan, mother of four children 
ranging in age from six to 11, left her 
native West Pakistan almost five years 
ago to come to the United States for 
further formal training in pediatrics and 
public health. Since that time she has 
become "the spirit and one of the most 
dynamic forces in the University of Mary- 
land Department of Pediatrics." 



Dressed in her native sari, her serene 
face, long black hair pulled in a bun and 
gentle manners are perhaps contradictory 
to her constant drive and concern for all 
human beings. However, she feels just 
as much at home in Baltimore counseling 
teenage mothers on health practices, con- 
traception and prevention of teenage 
pregnancies as she did expounding the 
values of infant care to a farmer's wife 
in West Pakistan where she was bom. 

Her typical day is packed with co- 
ordinating community projects and even 
though she has a busy schedule she's 
never too busy for a mother, child, 
student, or visitor to consult her. Dr. 
Khan sees no other way than to involve 
herself in community programs. Her 
husband and children live with her in 
Baltimore. 

Dr. Marvin Cornblath, Professor and 
Head, Department of Pediatrics, called 
Dr. Khan "one of the most unusual hu- 
manitarians . . . women . . . physicians, 
human beings and mothers . . . it's been a 



24 



Volume 56, No. 2 



privilege to know and work with her. 
You go through life and only meet one 
person like her. She has the ultimate 
concern for every human being by doing, 
not planning ... by doing what she can 
to help each and every one. 

"She is the spirit and one of the most 
dynamic forces in our department. As my 
first chief resident she worked with a 
total house staff of nine . . . it's now up 
to 21 and by July it'll be 28. As we've 
added new staff Dr. Khan has found five 
meaningful jobs for them in which they, 
the staff, the patient and the medical 
student have always gained, or benefitted. 

"She is an irreplaceable loss. We'll con- 
tinue to seek and achieve our missions 
and goals, but we'll never be able to do, 
without her, what we could have done 
with her." 

"She's a beautiful person . . ." 

"Dr. Khan is one of our most active 
and effective teachers at the student and 
house officer level. She is a catalyst among 
the various paramedical personnel as re- 
lates to the patient and has taught all 
of us what the 'team' approach to the 
patient and his problem really is," said 
Dean John H. Moxley, III. "Her talents 
and personality will be missed when she 
returns to West Pakistan." 

Dr. Khan served as pediatrician to 
the United Christian Hospital in Lahore 
from October 1962 to June 1966 as well 
as being the only pediatrician at the West 
Pakistan Research and Evaluation Center 
in Lulliani. She came to the United States 
in 1966 to obtain additional formal train- 
ing in pediatrics and in public health. Dr. 
Khan holds certification from the Ameri- 
can Board of Pediatrics and has a master's 
degree in Public Health from Johns 
Hopkins School of Hygiene and Public 
Health. She has been on the Pediatrics 



faculty for two years and has been in 
charge of developing, evaluating and 
implementing community programs in the 
Department of Pediatrics, University of 
Maryland School of Medicine. 

Under the direction of Dr. Cornblath 
and Dr. Khan, a wide spectrum of com- 
munity programs have been initiated and 
implemented. With Dr. Khan's return to 
Pakistan at the end of March, Drs. Murray 
Kappelman and Eric Fine will assume 
these responsibilities. 

"Perhaps the inner cities, ghettos, and 
slums with their unforgiveable living con- 
ditions for the masses of people exist 
as they are today because we are what 
we are. The changes may lie in the 
out-reaching hands of the students today, 
the builders of the future who have not 
yet reached the pinnacle of their contri- 
butions nor inflexibly established their 
beliefs nor have had their say as have 
some of their professors," the Pakistani 
physician observed. 

Dr. Khan made the preceding observa- 
tion in establishing a home care program 
in which pediatric patients can be treated 
with much more thoroughness and with 
less expense at home than in a hospital. 
In such a program better perspective is 
obtained of the child's total needs. 

"As a teacher, we fail our students 
if we teach them only the pathology of 
disease. We neglect them if we do not 
invest an awareness of all the facets of 
the circumstances that surround the child 
at the time of his illness," she explained. 

Dr. Khan continued, "The child and 
his illness are immeasurably affected by 
the family constellation, the home con- 
dition, the hygiene, the plumbing, the 
roaches, rats, the physical and mental 
health of the family members as well as 
the neighbors. There is an area to be 



April, 1971 



25 



covered in obtaining the history of the 
ill child which is rarely taught in the 
medical schools and rarely observed by 
those people involved in the child's care; 
the quality of the child's life," 

Speaking of her work with the preg- 
nant girls at Edgar Allan Poe Schools 
No. 1 and No. lA. Dr. Khan said: 

"This is the time when these young 
girls need the most help. They need infor- 
mation on prenatal care, advice on how 
to plan for their lives and most of all 
how to prevent further unwanted pregnan- 
cies. You can't shut your eyes and ignore 
these girls. They need help not condem- 
nation. It is easier to condemn them 
than it is to take care of their problems." 

The objectives of the teenage mother 
program are to augment the school's 
educational program, provide antenatal 
and well baby care as well as impart in- 
formation regarding family planning, job 
objectives, planning for the future, better 
utilization of existing services, and sex 
education. 



Other community programs in which 
Dr. Khan plays a role: 

Maryland State School for the Blind — 
The Department of Pediatrics since June 
1969 has undertaken the total medical 
care of the State of Maryland's blind 
children registered at the school. This in- 
volves delivery of comprehensive health 
services including psychiatry, dentistry, 
nutrition and obesity studies as well as 
the use of nurse practitioners. 

The Community Pediatric Center — 
This center offers comprehensive medical 
services to a child population of about 
10,000 children. This program involves 
service, education and research as well 
as continuing evaluation. 

Citizen's Council — In line with the Uni- 
versity of Maryland's deep commitment 
to the inner city community a Citizens 
Council was established consisting of 
parents using Pediatric Services, com- 
munity leaders, representatives of service 
personnel in the Department as well as 
representatives of community agencies. 







f 



HOUSE STAFF 1968-69— Dr. Misbah Khan is shown with other members of the Department 
of Pediatric's house staff when she was Chief Resident. Front row, left to right. Dr. Jane 
.McCaffery, Dr. (iary Fleming, Dr. Marvin Cornblath, professor and head. Department of Pedi- 
atrics, Dr. Khan, and Dr. Eric Fine. Back row, left to right. Dr. Robert Gingell, Dr. Shih-Wen 
Huang, Dr. Kenneth Koskinen, Dr. John Ignatowski, and Dr. Theodore Wolfe. 



26 



Volume 56, No. 2 



You are cordially invited to attend 

THE FIRST ANNUAL 

MISBAH KHAN 

LECTURE IN PROBLEMS OF 
WORLD HEALTH 



SponioreJ by 

The Pediatric Di-p.irlment 
UNIVERSITY OF MARYLAND 

SCHOOL OF MEDICINE 




12 NOON 

THURSDAY. FEBRUARY 25, 1971 

CONrtRENCr. ROOM 1-704 

UNIVERSITY or MARYLAND HOSPITAL 

BALTIMORE, MARYLVND 



"This certificate is presented to Dr. 
Misbah Khan in recognition and in ap- 
preciation of her immeasurable contri- 
butions to the Department of Pediatrics, 
to mothers, to children, to the community 
and to the State of Maryland. Teacher, 
friend, physician, humanitarian, citizen 
of the world . . . Dr. Khan's place in the 
department and in our hearts will be 
forever honored for her compassionate 
service to all. A woman of action, gentle 
but firm, dynamic yet patient Misbah 
Khan's foremost concern is always man's 
humanity to man. Her example, her con- 
tributions, her devotion, her achievements 
will remain always as a goal for all to 
emulate." 

February 25, 1971 

Marvin Cornblath 
Professor and Head 
Department of Pediatrics 



Fellowship in the Maryland State 
Health Department — In October 1970 a 
program was begun with the State Health 
Department in which resident physicians 
become acquainted with problems of the 
community and administrative medicine. 

Neighborhood Youth Corps In-School 
Program — In April 1970 a program was 
initiated for 16 high school youngsters 
in areas of service such as nursing, secre- 
tarial, laboratory, child life, etc. 

Dr. Khan cannot stress enough the im- 
portance of infant and child care. When 
she returns to her home she hopes to 
begin a program of comprehensive ma- 
ternal and child health services on family 
planning and family health in rural 
villages. 

"To preach birth control to a woman 
in the village who knows nothing about 
childhood diseases, nutritional values and 
preventive medicine is wrong," said Dr. 



Khan. 

She says the basic needs of health 
measures in Pakistan are water supply, 
waste disposal and compulsory immuniza- 
tion. 

"We need legislative measures to give 
health care the first priority," she said. 
"The need of Pakistan is in implementing 
ways to train health aides and utilizing 
available resources from the women of 
the village so they can staff village clinics 
and augment the shortage of doctors. 
She said that 93 per cent of the country's 
population is concentrated in villages. 

Dr. Khan, who will be chief of pedi- 
atrics. United Christian Hospital, Lahore, 
West Pakistan, would like to see two 
things accomplished in her country dur- 
ing her lifetime: compulsory immuniza- 
tion and compulsory education. 

She concluded: "Values and needs of 
human beings are the same everywhere." 



April, 1971 



27 



RAMSAY NAMED 




Dr. Ramsay 

Dr. Frederick J. Ramsay has been named 
Assistant Dean, Student Affairs, by Dean 
John H. Moxley, III. 

He succeeds Dr. George A. Lentz, Jr., 

who has assumed the directorship of the 
Community Pediatrics Center (CPC) full- 
time. 

"The Office of Student Affairs is the pri- 
mary link between the students, the faculty, 
the administration, the alumni and other 
groups," said Dr. Ramsay. 

He added. "We are charged with the 
responsibility of overseeing the distribution 
of scholarships, loans and grants in aid; 
the management of student activities; 
scheduling senior elective opportunities and 
miscellaneous registrar functions, and for 
both personal and professional counseling." 

Dr. Ramsay chairs the Advancement 
Committee, Student Activities Committee, 
the Scholarship and Loan Committee, and 
the Honors and Graduation Committee. He 
is a member of the Curriculum Committee, 
the Internship Advisory Committee and the 
Senior Elective Committee. 

"Future plans call for the establishment 
of a housing bureau, a job placement service 
and an extensive student advisory system," 
said Dr. Ramsay. 



In July 1970, Dr. Ramsay was named the 
first director of the Office of Research in 
Medical Education. It was established to 
study the school's present curriculum and 
to plan changes that would fit the needs 
of changing medical practice and the de- 
mands of a changing society. 

Dr. Ramsay, who taught Anatomy at the 
medical school from 1964-69, spent a year 
at the Center for the Study of Medical 
Education conducted by the University of 
Illinois School of Medicine in Chicago. 

In addition to directing the Office of Re- 
search in Medical Education he has con- 
tinued to teach embryology. 

The Baltimore native, also an ordained 
Episcopal minister, was raised on the 
McDonogh campus where his father, A. 
Ogden Ramsay, has taught Biology for 
over 40 years. He himself earned a bache- 
lor's degree in Biology at Washington and 
Lee University, Lexington, Va., and re- 
ceived M.S. and Ph.D. degrees in Anatomy 
and a M.E.D. in Medical Education from 
the University of Illinois School of Medi- 
cine. 

Also a Baltimore native, Dr. Lentz suc- 
ceeds Dr. Ray Hepner, who is now Di- 
rector of Research for the CPC. 

Dr. Lentz received his M.D. from the 
University of Maryland School of Medicine 
in 1957 after attending Johns Hopkins Uni- 
versity for his A.B. degree. He interned, held 
his Pediatric residency and later a fellow- 
ship in Physical Medicine Rehabilitation at 
the University of Maryland Hospital. He 
was assistant professor of Pediatrics 1964- 
68. Currently he is an assistant professor. 
Physical Medicine and Rehabilitation, and 
an associate professor of Pediatrics. 

His hospital appointments include: chief, 
Department of Pediatrics, Lutheran Hospi- 
tal, 1964-67; pediatrician, James L. Kernan 
Hospital for Crippled Children, and pedia- 
trician. University of Maryland Hospital. 
He is also medical director. United Cerebral 
Palsy Center of Baltimore, Inc., and di- 
rector, Mental Retardation Center. 



28 



Vohiine 56, No. 2 



Would you, could you 
on a boat? 







^ 





Eat Green Eggs 
and Ham . . . 



April, 1971 



29 





20 



Volutne 56, No. 2 



Anything Is Possible 
In the World of Kids 




JFT OfRTRUW UF HMt£\ 
CE AU mill! B(AJCS AMD 
IV HFt Mac HOMF IT 
" " T TWOWHKS 



' IT TOOH ALMOST 
'THlVWnKMOftl tOPUll 
imfcf FIATMtRS 

(JOmiUOl WAS SOPF 



On the 5th Floor 
Pediatrics Ward 

AT UNIVERSITY HOSPITAL 



'^ Dr. Seuss Drawings designed by Carol Stretch and painted by 
Joseph Ford, both art students. 

April, 1971 31 



AMBULATORY NURSING 



The Department of Ambulatory Nurs- 
ing Services is undergoing a period of 
change as the University Health Science 
Center begins to respond to the need for 
improving the delivery of health services 
and the health manpower shortage. 

"Because there is an increasing empha- 
sis on ambulator}' care as well as an in- 
crease in the number of patients, the 
Ambulatory Health Services staff has 
sought more effective means of delivering 
the best health care to the greatest num- 
ber of people," stated Dr. William S. 
Spicer, associate dean for Health Care 
Programs. "Among the ways this may 
be achieved are through Nurse Oinics 
and further education of the nurse." 

In present and future programs, the 
Ambulatory Nurse may participate as a 
nurse practitioner or care team leader, 
and may supervise preventive mainte- 
nance and surveillance clinics for chronic 
diseases, direct screening and triage 
functions. She may also provide leader- 
ship in community health situations, 
specialty emergency and treatment roles, 
patient education and family planning. 

"With the creation of new educational 
programs, careers, primary and specialty 
health care teams, the nurse will play 
an expanded, pivotal role in the six C's 
of good care: continuity, coordination, 
compassion, competence, comprehensive- 
ness, and community responsibility and 
involvement," Dr. Spicer added. 

In November, Dr. Samuel T. R. Revell. 
chief of the Medical Clinic. Mrs. Rachel 
Booth, RN, associate director of Nurs- 
ing, and Mrs. Rose Rieger, RN, team 
leader for the Medical Clinic, with the 
cooperation of the nurses on her team, 
initiated plans for a "Nurse Clinic" in 
Ambulatory Services. A group of patients 
with the diagnosis of diabetes mellitus 



was selected for the first clinic. A proto- 
col outlining patient care was developed. 

In the Nurse Clinic the physician 
makes the initial diagnosis, prescribes 
specific therapy, and refers select patients 
to the nurse. The nurse accepts the re- 
ferral, provides a continuing surveillance 
of the disease and promotes the mainte- 
nance of health through observation and 
teaching. Plans have been made to refer 
the patient back to the physician for 
periodic examinations and consultations. 

"Nurses and physicians have recog- 
nized the need to determine their func- 
tions and roles in order to maximize the 
utilization of each profession. It is be- 
coming increasingly evident that compe- 
tent professional nurses can make tre- 
mendous and independent contributions 
to the maintenance care of patients with 
such chronic diseases as obesity, hyper- 
tension, diabetes mellitus, pulmonary dis- 
ease and psychosomatic disorders," Dr. 
Spicer explained. 

At the University of Maryland, an ex- 
tensive staff development program in 
Ambulatory Nursing is being planned to 
prepare nurses for their responsibilities in 
this area. A staff development committee, 
formed last year, is offering lecture series, 
conferences, films and classes on subjects 
basic to progressive nursing. 

One of the presentations which was 
given by Drs. Leonard Scherlis, Jerry 
Salan and other members of the Division 
of Cardiology was on intensive coronary 
care. In a series of ten demonstrations, 
the nurses learned about cardiopulmo- 
nar>' resuscitation, coronary artery disease, 
electrocardiography, and aarhythmias in 
order to extend effective therapy for 
cardiac emergencies from the intensive 
care units to Ambulatory Services and, 
hopefully in the future, into the com- 
munity. 



32 



Volume 56. No. 2 



The Electrodiagnosis of 
Neuromuscular Disease 



Frank Kemble, M.D., M.R.C.P. 



Neuromuscular disorders are caused by 
diseases of the lower motor and sensory 
neurones. They are best diagnosed by 
clinical criteria but when clinical differ- 
entiation is difficult, then reliance must 



Instrumentation 



AVERAGER. 



be placed upon electrodiagnostic, histo- 
logical and biochemical investigations. ' 

This article describes the basic electro- 
diagnostic procedures together with their 
usefulness and limitations in differentiat- 
ing neuromuscular disease. 



OSCILLOSCOPE. 




trigger input 

for timebase. 




STIMULATOR. 



AMPLIFIER. 



n 



ISOLATING 
TRANSFORMER 

[or unit] 



VDXSt 



^ 




fflrcro 



recording 
elect rodes. 



stimulating 
electrodes. 



Fig. 1 



The above diagram of the equipment 
layout (Fig. 1) is fairly self explanatory. 
An averaging device or an oscilloscope 
may be used for recording nerve and 
motor unit potentials. 



Electrodiagnostic Procedures 

A simple classification of electrodiag- 
nostic neuromuscular procedures is given 
below. These will then be described more 
fully in the text. 



April, 1971 



2i 



A. Nerve Conduction 

1. Sensory and motor conduction 

2. (H) reflex testing 

3. Strength-duration curves 

B. Muscle Sampling 

Sensory and Motor Nerve Conduction: 

The technique for measuring nerve 
conduction involves applying a stimulus 
to a peripheral nerve and then recording 
the transmitted nerve or muscle action 
potential so that a conduction time or 
latency is obtained between the stimulus 
artifact and the action potential. 

The stimulus is a product of current 
duration and strength, the latter being 
measured in either amperes or volts. 
Either one of the three variables, i.e., 
time, amperage, or voltage, can be varied 
leaving the other two constant. 

The availability of peripheral nerves 
for testing depends upon their relation- 
ship to the surface of the extremity. 

This means that some nerves are 
particularly accessible to testing, such 
as the median and ulnar nerves in the 
arms, the common peroneal and pos- 
terior tibial nerves in the legs, and the 
facial nerves. Other nerves are more 
difficult to test because they lie some- 
what deeper, buried within the soft 
tissues of the extremities. These in- 
clude the radial and musculocutaneous 
nerves in the arm and the femoral and 
sciatic nerves in the leg. Conduction 
is extremely difficult to measure in 
nerves other than those listed above. 

The relationship of peripheral nerves 
to the surface also limits the extent to 
which nerve conduction can be measured 
along their course. The following is a list 
of peripheral nerves and the extent to 
which conduction can be measured along 
their course: 



median nerve — digits up to the axilla 
ulnar nerve — digits up to the axilla 
radial nerve — digits up to the axilla 
common peroneal nerve — digit up to 

the sciatic notch 
posterior tibial nerve — digit up to the 

sciatic notch 
femoral nerve — mid thigh up to the 

groin 
facial nerve — the stylomastoid foramen 

to the facial musculature 




Typical muscle action potential (A- ampli- 
tude 3000^;^ V) and sensory nerve action po- 
tential (B-Amplitude 100^ V). 

Fig. 2 

Sensory and motor conduction can 
both be measured in peripheral nerves. 
Sensory conduction may be affected (de- 
layed) before motor conduction in many 
neuropathies and, therefore, may be a 
more sensitive indicator of disease than 
motor conduction. However, a sensory 
nerve action potential (SNAP) is between 
25 to 200 times smaller than a muscle 



34 



Volume 56, No. 2 



action potential (MAP) and is, therefore, 
more difficult to record (Fig. 2). Sensory 
recording is further complicated by the 
fact that snap's decrease in amplitude 
with increase in age and with lowering 
of limb temperature, therefore under 
these two conditions (age and low 
temperature), measurement of the small 
snap's can be extremely difficult and 
inaccurate. These problems can be over- 
come to some extent by warming limbs 
before testing and by summating re- 
sponses on an averaging device which 
summates any constant baseline abnorm- 
ality and rejects inconstant variations 
from the baseline. 

Reduced peripheral nerve conduction 
is the most obvious measure of peripheral 
nerve disease. Less constant abnormalities 
include decrease in the amplitude of the 
MAP and SNAP, increase in their dur- 
ation and alterations in refractory periods 
with paired stimuli. 

Nerve fiber conduction velocity is pro- 
portional to nerve fiber diameter, the 
fastest conducting fibers being those of 
the largest diameter (nerve liber diameter 
in fji X 6 — the velocity of conduction 
in meters/second). 

There are two likely conditions which 
cause reduced conductive velocity. The 
first is segmental demyelination, either 
limited to a segment of a nerve fiber or 
affecting the nerve fiber along the whole of 
its course. The second is regeneration of 
nerve fibers after Wallerian degeneration. 
(This must presume that all fibers in a 
peripheral nerve degenerated initially, 
since theoretically only a few fibers of 
normal diameter need to survive for nerve 
conduction to be maintained. This latter 
state of affairs sometimes occurs in motor 
neuron disease and poliomyelitis, i.e., 
diseases which involve the anterior horn 
cells). 



Detailed steps in the measurement of 
median nerve conduction will now be 
described since the basic technique is 
similar for other peripheral nerves. 

1. Make sure that the limb is warm 
which means that either the surface 
temperature must be over 30 °C or the 
room temperature must be over 26 °C. 

2. Apply a weak stimulus to the 
skin above the wrist and find the point 
which will evoke the maximal visible 
twitch of the thenar muscles. Mark the 
stimulating point and the one of maxi- 
mal muscular twitch, and then repeat 
using the same technique medial to 
the bicipital tendon at the elbow and 
at the axilla. These "stimulating" points 
can now be used for stimulating (motor 
conduction) and for recording (sensory 
conduction), since we now know that 
at these points the median nerve is 
at its closest to the surface. 

3. Evoke a SNAP by stimulating 
either the index finger or all of the 
median innervated fingers with ring 
electrodes and record the evoked re- 
sponse at the wrist, elbow, and axilla. 
The conduction times are measured 
from the onset of the stimulus artifact 
on the oscilloscope to the peak of the 
initial positive (downward) deflection 
of the SNAP. These conduction times 
are measured upon an oscilloscope or 
averaging device which has two beams, 
one of the beams being used to record 
the SNAP, the other being used to 
record a time base measured in milli- 
seconds (1,000th of a second). 

4. Measure the distances between 
the proximal ring electrode and the 
distal electrode of the pair of recording 
electrodes at the wrist, elbow, and 
axilla. These measurements are usually 
made in centimeters by using a metal 
tape measure. 



April, 1971 



35 





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36 



Volume 56, No. 2 



5. There are now available three 
conduction times (Fig. 3) which 
represent sensory conduction between 
finger and wrist, finger and elbow, the 
finger and axilla respectively. Con- 
duction times between the wrist and 
elbow and between the elbow and 
axilla can now be calculated by simple 
subtraction. These conduction times 
in milliseconds are now divided into 
the conduction distance in centimeters 
which gives a velocity measured in 
centimeters per millisecond or which 
can, in turn, be completely multiplied 
by 1,000 to give a velocity in meters 
per second. It must always be re- 
membered that theoretically the sensory 
velocity measures the rate of con- 
duction of the fastest (largest) digital 
sensory nerve fiber. Sensory conduction 
can also be measured up the arm fol- 
lowing stimulation of the median nerve 
trunk at the wrist. 

6. Motor conduction can be meas- 
ured in a similar way, if it is remem- 
bered that on this occasion we are 
stimulating at either the axilla, elbow, 
or wrist and recording over the thenar 
muscles, and also remember that the 
terminal motor conduction time is a 
compound time, not simply resulting 
from nerve conduction but also result- 
ing from conduction in the terminal 
branches of the fibers of the median 
nerve together with delay at the neuro- 
muscular junction. It can, therefore, 
only be used empirically as a measure- 
ment of neuromuscular conduction 
against a set of normal values. 

7. Approximate normal values for 
median nerve conduction: 

Distal motor latency — 2 to 4 
msec. 

Motor conduction, wrist to el- 
bow — 56 ±10 M/sec 



Motor conduction, elbow to 
axilla— 65 ± 10 M/Sec 

Sensory velocity, finger to wrist 
—60 ± 10 M/Sec 

Sensory velocity, wrist to elbow 
—62 ± 10 M/Sec 

Sensory velocity, elbow to axilla 

—72 ± 10 M/Sec 

Radial and ulnar nerve conduction can 
be measured in a similar way to median 
nerve conduction. When measuring in the 
legs it must be remembered that con- 
duction is slightly reduced in the per- 
ipheral nerves of the leg compared with 
the arms. 

Abnormalities of Nerve Conduction 
may involve many peripheral nerves, 
single nerves or only segments of one 
peripheral nerve. 

Localized delay is seen in the so- 
called "entrapment" neuropathies, such 
as in the median nerve at the wrist 
in the carpal tunnel syndrome, the 
ulnar nerve at the elbow, and the 
lateral popliteal at the head of the 
fibula. The conduction measured in 
other segments of these nerves is 
normal. 

Generalized delay in all of the 
measurable nerve segments is seen in 
the aff"ected nerves of polyneuropathies 
or mononeuropathies. 

Marginal or no delay of nerve con- 
duction is seen in either radicular les- 
ions or in lesions involving either the 
dorsal root ganglion cells or the an- 
terior horn cells. It should be noted 
that the evoked muscle action potential 
may be polyphasic in all three of the 
above groups compared with normal 
potentials. 



April, 1971 



Z7 



SPINAL CORD 




^A-V 



2msec 
MiiiiiiinniiniiiiiiiiK 



Fig. 4 

A — "H" reflex testing; The stimulus at S evokes a response recorded by R. 
B to G show the recorded H and M responses with increasing stimulus strength. 



"H" Reflex Testing 

"H" reflex testing is the electrophysio- 
logical equivalent of the tendon jerk 
(muscle stretch reflex). The basic 
principle is that a weak threshold stimulus 
which is lower than that used to stimulate 
motor fibers will evoke a response. "H", 
at a latency of approximately 25 to 30 
milliseconds from the stimulus artifact 
(B to D — Fig. 4). This is due to con- 
duction proximally along the spindle 
afl"erent tibers, across the monsynaptic 
junction of these fibers with the anterior 
horn cells, and then down the motor nerve 
fibers to cause a muscular twitch in the 
triceps surae muscle. Upon increasing the 
threshold of this weak stimulus, a second 
response is recorded which has a much 
shorter latency (E to G — Fig. 4). This is 
the direct response from stimulating the 



motor nerves to the triceps surae muscle 
and is called the "M" response. The 
amplitude of the M or muscle response 
increases with increasing strength of the 
electrical stimulus and, in turn, the ampli- 
tude of the '"H" or late response de- 
creases. The practical significance of this 
reflex is that the "H" wave amplitude 
is increased and the "H" reflex cycle to 
paired stimuli is abnormal in extra-pyra- 
midal or pyramidal tract lesions, and the 
reflex may be abolished or delayed by 
diseases which afl'cct the muscle spindle 
or nerves. 

Strength Duration Curves 

Strength-duration curves (S-D curves) 
have been supplanted in the majority of 
instances by a combination of muscle 
sampling and nerve conduction which are 



38 



Volume 56, No. 2 



50 mA^ 



totally denervated 
muscle 



stimulus 
intensity 




partially denervated 
muscle 



chronaxie 



rheobase 



100 msec. 



Typical strength 
muscle. 



current 
duration 

Fig. 5 
duration curves in normal muscle, partially and completely denervated 



simpler and probably technically easier 
to perform. Strength-duration curves are 
interpreted by utilizing certain neuro- 
physiological principles. Firstly, tissues 
vary in their excitatory thresholds and 
also in their decay rates. Secondly, the 
decay rate is a measurement of the in- 
creased duration of stimulus needed as 
the stimulus threshold reduces. Thirdly, 
muscle fibers have a low decay rate and a 
high excitatory threshold and are best 
stimulated by long duration currents (see 
Fig. 5). Nerve fibers have a high decay 
rate and low excitatory threshold and, 
therefore, respond better to short duration 
stimuli (see Fig. 5). 

The significance of strength duration 
curves is that they indicate denervation 
and were used for following the pattern 
of regeneration following denervation. As 
can be seen in the diagram (Fig. 5), a 
partially denervated muscle will exhibit a 



curve which is intermediate between the 
strength duration curves for totally de- 
nervated and normal muscle. Totally de- 
nervated muscle gives a S-D curve equiva- 
lent to that of isolated muscle. 

The chronaxie and rheobase are 
measurements used to quantitate strength 
duration curves. The chronaxie is the 
duration of current needed to cause 
muscular contraction by using a current 
strength of twice the rheobase. The rheo- 
base is the lowest strength of current 
needed to stimulate a particular muscle 
regardless of the duration of the current 
flow. 

Normal muscles respond vigorously to 
Faradic stimulation (A/C) for as long 
as the current is passing. They respond 
to Galvanic stimulation (D/C) only 
when the current is made or broken. In 
a lower motor neuron lesion, there is no 
response to Faradism after 5-7 days be- 



April, 1971 



39 



cause of the short current duration (Fig. 
5), but there is a response to Galvanism 
which, however, requires a stronger 
current than in the normal muscle (see 
S-D curve complete denervatcd muscle 
in Fig. 5). This change of response to 
Faradic and Galvanic stimulation by de- 
nervatcd muscle is called the reaction of 
degeneration. It has been supplanted by 
charting strength/duration curves, and in 
practical terms the latter have been sup- 
planted by muscle sampling and nerve 
conduction studies. 

Muscle Sampling 

Muscle sampling is performed by in- 
serting a needle recording electrode into 
the muscle to be tested and electrical 
activity is observed upon an oscilloscope. 
The instrumentation is no different from 
that used for conduction studies other 
than the fact that the time base is "com- 
pressed" by using 20 msec, to cover ap- 
proximately 1 cm. instead of 1 msec/cm. 
as with nerve conduction. The oscillo- 
scope tracing is set to run continuously so 
that immediately the trace "runs off" one 
end of the oscilloscope it then reappears 
at the opposite end. This enables visuali- 
zation of many MUP's together. 

The next step is to observe for spon- 
taneous electrical activity in the muscle 
at rest after, but not during, insertion of 
the needle electrode. Normally a muscle 
is absolutely silent at rest but in patho- 
logical conditions abnormalities may be 
found such as fibrillation potentials, 
positive sharp waves, fasciculation po- 
tentials and myotonic discharges. 

Fibrillation potentials (Fig. 6) indi- 
cate denervation, are found five days 
after denervation has commenced and 
are found at their most profuse level 
between 15 and 20 days following 
denervation. They may persist for 
months or even years. They exhibit a 




Fig. 6 

Fibrillation potentials and a positive sharp 
wave. 



high pitched crackling noise on the 
audio link from the oscilloscope and 
repeat themselves regularly, like the 
crackling of fat in a frying pan. The 
following are parameters of fibrillation 
potentials : 

a. amplitude, 10 to 600 microvolts 
(average less than 100 micro- 
volts) 

b. duration. 1 to 2 msec. 

c. disphasic and occasionally tri- 
phasic 

d. 2 to 30 second intervals (aver- 
age 10 second intervals) 

Positive sharp waves (Fig. 6) also 
indicate denervation and have been at- 
tributed to the synchronous discharge 
of a number of denervated muscle 
fibers, compared with a fibrillation po- 
tential arising from a single completely 
denervated muscle fiber. They have a 
dull, thud-like sound on the audio link 
from the oscilloscope. The following 
are parameters of these positive sharp 
waves: 

a. variable voltage 

b. duration up to 100 msec. 

c. disphasic 

d. 2 to 100 second intervals 

Fasciculation potentials are at- 
tributed to the spontaneous firing of 



40 



Volume 56. No. 2 



motor units. They are found in the 
presence of denervation (especially in 
anterior horn cell degeneration), nerve 
root "irritation," and in benign 
myokymia. They, therefore, may or 
may not indicate denervation when 
found on their own. 




Fig. 7 

A polyphasic motor occurring in a denerva- 
tion fasciculation, together with fibrillation 
potentials. 

Denervation fasciculations (Fig. 7) 
have the same parameters as the poly- 
phasic potentials evoked by voluntary 
contraction. One exception is the large 
(often > 10 mV) fasciculation po- 
tentials sometimes seen in anterior horn 
cell degeneration and less often in 
chronic neuropathies. 




Fig. 8 

Triplets of triphasic potentials occurring in 
fasciculations of motor root irritation. 

In nerve root irritation, the fascicula- 
tion potentials are usually di- or tri- 
phasic and not polyphasic. They 
characteristically tend to occur in 
groups of 2 or 3, called doublets or 
triplets (Fig. 8). 





^^^^^^!^^B 




■ 


^ss^^^^^^i 


^B 



Fig. 9 

A group of normal MUP's occurring in a 
fasciculation of benign myokymia. 



In benign myokymia, the fasciculation 
potentials may not be polyphasic if 
recorded with a bipolar needle elec- 
trode. They tend to occur as a cluster 
of spontaneously but normally formed 
MUP's (fig. 9). Contraction fascicula- 
tions appear as groups of normal 
MUP's evoked by minimal movement 
and are therefore not spontaneous. 




Fig. 10 

Spontaneous myotonic discharge of simple 
short duration action potentials. 



Myotonic discharge occurs spon- 
taneously and wanes both in amplitude 
and frequency with a sound like a dive 
bomber. The individual action po- 
tential parameters may vary between 
a normal muscle action potential and 
a fibrillation potential, and some of 
these are probably due to sarcolemmal 
membrane abnormality. The most 
characteristic potentials are of short 
duration and of low voltage (Fig. 10). 
Prolonged myotonic discharge is 



April, 1971 



41 



characteristic of clinical myotonia. 
Repetitive high frequency discharge 
which is unsustained can be found in 
clinical myotonia but also in other 
neuromuscular disorders and even in 
apparently normal persons. 

Having observed the absence or 
presence of electrophysiological activity 
at rest in the muscle to be tested, we now 
proceed to observe if there are any motor 
unit potentials following contraction by 
the patient of the muscle against the in- 
serted needle recording electrode. By 
this means, scattered, individually dis- 
persed, motor unit potentials may be re- 
corded. These can be observed and photo- 
graphed for parameters such as the ampli- 
tude, duration, number of phases, etc. 



The characteristic normal motor 
unit potential evoked by muscular con- 
traction has the following parameters, 
however, these can vary considerably 
with different muscles. 

amplitude, 100 to 2,000 microvolts 

duration, 5 to 15 msec. 

number of phases, 2 to 4 (usually 3) 

recur at 2 to 25 second intervals 

They have a plunk-like sound on the 
radio link from the oscilloscope. 

There are 2 types of abnormal motor 
unit potentials, both of which are poly- 
phasic, and indicate neuromuscular 
disease. One type consists of polyphasic 
muscle action potentials with similar 
parameters to normal MUP's other 
than the extra number of phases. 



\ r f f / :z3 



/ 



[1 




^ 




SIMPLE MONOPOLAR NEEDLE 
RECORDING ELECTRODE WITH 
DISTANT INDIFFERENT ELECTRODE. 



"MONOPOLAR" CONCENTRIC 
NEEDLE RECORDING ELECTRODE. 



BIPOLAR CONCENTRIC NEEDLE 
RECORDING ELECTRODE. 



Fig. 11 



42 



Volume 56, No. 2 



These potentials probably indicate rein- 
nervation and their parameters are 
listed below. 

amplitude. 20 to 5,000 microvolts 

duration, 2-25 msec. 

number of phases, 5-25 

recur at 2 to 50 second intervals 

They have a typically rasping char- 
acter on the audio link from the oscillo- 
scope. 

It has been stated that these poly- 
phasic potentials occur in between 1 
and 12 per cent of normal individuals, 
but they are not usually found when 
using bipolar needle electrodes which 
considerably limit the pickup or record- 
ing area (see Fig. 11). It may well be 
that the previous description of poly- 
phasic potentials occurring in normal 
individuals was due to distant record- 
ing by simple monopolar or mono- 
polar concentric needle electrodes from 
a greater area than when recorded with 
bipolar electrodes. Thus, a distant po- 
tential superimposed upon one lying 
closer to the needle would give the 
appearance of simple single polyphasic 
potential. Giant polyphasic units with 
amplitudes of over 10 millivolts are 
often found in anterior horn cell de- 
generations. These giant units occur 
less often with more peripheral de- 
nervation and subsequent regeneration 
with peripheral sprouting; e.g., in 
chronic polyneurophathies. 

The second type of abnormal motor 
unit potentials are of low amplitude 
and short duration and are character- 
istic of primary muscular disease. Their 
parameters are at the lower end of 
the normal range for muscle action 
potentials with regard to amplitude and 
duration. They may even simulate 
fibrillation potentials (100 microvolts 
amplitude and 1-2 seconds duration), 



although they obviously occur only on 
volition. They have a characteristic 
high pitched noise and many of them 
are polyphasic. 

The pattern of motor unit potentials is 
now observed following a maximal 
sustained voluntary contraction by the 
patient. There are three typical patterns. 




Fig. 12 

Development of maximum muscular 
contraction in a normal muscle (Fig. 
12) gives a typical crowded grouping 
of MUP's with similar amplitudes. 




Fig. 13 

Denervation is characterized by a 
marked reduction of the total number 
of motor units on maximum muscular 
contraction (Fig. 13). Many of the 
surviving motor units are polyphasic 
and smaller than normal in the early 
stages of the disease. Later the pattern 
changes in that the surviving polyphasic 
units may be of larger than normal 
amplitude. This pattern is often de- 
scribed as a discrete motor unit pattern. 




Fig. 14 

Potentials characteristic of primary 
muscular disease are reduced in ampli- 
tude and duration (Fig. 14). When 
many of these MUP's are evoked by a 
maximum muscular contraction, they 
give an appearance of being crowded 
together (more MUP's per con- 
traction). 



April, 1971 



43 



Typical Findings in Various 
Neuromuscular Diseases 

Typical electrophysiological findings in 
neuromuscular diseases are tabulated be- 
low. 

A. Peripheral Neuropathy 

1 . nerve conduction 

a. This is usually impaired after 
one or two weeks (sometimes 
earlier) 

b. Sensory conduction is impaired 
more than motor conduction 
but often the former can only 
be tested satisfactorily in the 
arms since no SNAP's are re- 
cordable in the legs. 

c. All of the nerve segments be- 
low the elbow show a pro- 
portionate decrease of nerve 
conduction, while axillary con- 
duction may be normal. 

2. muscle sampling 

a. Spontaneous fibrillation po- 
tentials, positive waves and 
fasciculation potentials appear 
after the first week. On mini- 
mal muscular contraction poly- 
phasic motor units are seen and 
on full muscular contraction a 
discrete motor unit pattern 
occurs. 

B. Mononeuropathies (e.g., polyarteritis 
nodosa) 

Nerve conduction and muscle sampling 
findings are similar in all respects to those 
found in polyneuropathy except that they 
are limited to the distribution of one 
peripheral nerve. 

C. Entrapment Neuropathies 
1 . Nerve conduction 

a. There is a localized reduction 
of motor and sensory con- 
duction at the site of entrap- 



ment with normal proximal and 
distal conduction. In the 
median nerve there is delayed 
conduction across the wrist in 
the carpal tunnel syndrome, 
but normal conduction may be 
found both distally and proxi- 
mally. In practice, it is not 
easy to measure conduction 
just across the wrist or in the 
fingers alone, therefore a signifi- 
cant finding is taken as delayed 
conduction below the wrist, 
which is the average of normal 
conduction distal to the carpal 
ligament and delayed con- 
duction across the carpal liga- 
ment. 

b. muscle sampling — exhibits ab- 
normalities which are identical 
to those described in A and B. 

D. Proximal neurogenic lesions are those 
lesions which afifect the anterior horn 
cells and the motor roots, e.g., disc 
lesions. 

1. Nerve conduction. Usually this is 
normal or only minimally reduced 
but in rare instances can be com- 
pletely absent. The explanation for 
these findings is that conduction 
is measured along peripheral 
nerves which receive their inner- 
vation from more than one spinal 
cord segment. If all of the motor 
nerve fibers from one spinal cord 
level were lost, conduction would 
still be preserved in any given 
peripheral motor nerve since con- 
duction would be maintained 
along fibers from adjacent spinal 
cord segments. 

2. Muscle sampling. If the anterior 
horn cells or the motor nerve roots 
are affected, sampling abnormali- 
ties similar to those described in 



44 



Volume 56, No. 2 



A, B, and C may be found. Giant 
polyphasic potentials of 10 milli- 
volts are seen more often with 
proximal neurogenic lesions and 
motor root lesions are often as- 
sociated with coupling or tripling 
of simple diphasic or triphasic 
motor unit potentials. 

It should be noted that a 
sensory radiculopathy usu- 
ally cannot be diagnosed by 
electromyography since there 
will be no sampling ab- 
normalities and sensory con- 
duction will be normal or, in 
rare instances, completely 
lost. 

E. Clinical Myotonia 

1 . Nerve conduction — normal 

2. Muscle sampling — A rapid volley 
of motor unit potentials of short 
duration and low amplitude are 
evoked simply by inserting the 
needle into the affected muscle. 
These sound like a dive bomber 
(piston engine) on the audio link 
from the oscilloscope. These myo- 
tonic bursts seem to occur more 
or less spontaneously although, of 
course, they may be due to irri- 
tation due to minor movements 
of the point of the needle. They 
are sustained although they tend 
to wane. Unsustained high fre- 
quency discharges are seen in 
other diseases of the motor unit 
and even in apparently normal 
persons. 

F. Primary Muscle Disease 

I . Nerve conduction — Normal 



2. Muscle sampling — The motor 
unit potentials characteristically 
tend to approach the parameters 
of fibrillation potentials which are 
those of a single muscle fiber, i.e., 
they are of short duration and of 
low amplitude. Typically they have 
a high pitched sound on the audio 
link from the oscilloscope and ap- 
pear as small units densely 
grouped together. Some of the 
units on minimal volition seem to 
to be polyphasic. There is no 
spontaneous activity at rest. 

It is rare that one can differenti- 
ate between a polymyositis and 
a dystrophy or myopathy. In oc- 
casional cases, fibrillation po- 
tentials may be found in polymy- 
ositis, and these are sometimes 
attributed to the fact that edema 
surrounding the muscle fibers may 
cause compression and denerva- 
tion of fine intramuscular nerve 
terminals. 

G. Myasthenia gravis and the myasthenic 
syndrome. 

These findings are described under the 
assumption that a myasthenic syndrome 
can exist without other evidence of neuro- 
genic disease. A peripheral nerve such 
as the median or ulnar, is usually stimu- 
lated while examining for myasthenia. It 
should be noted that all of the neuro- 
physiological investigations may be 
normal in myasthenia gravis. 

The table shows the characteristic 
electrophysical changes in normal per- 
sons and in patients with myasthenia 
gravis and the myasthenic syndrome. 



April, 1971 



45 



Investigation 


Normal 


Myasthenia Gravis Myasthenic Syndrome 


1. Muscle sampling 


N 


N N 


2. Nerve conduction 


N 


N N 
(may get some delay 
of distal motor 
latency in severe 
myasthenia) 



3. Amplitude single 
MUP evoked by 
nerve stimulation 



N 



4. Repetitive stimuli 

Repetitive stimuli are delivered to 
the nerve for an estimated period and 
the MUP's are recorded in order to 



N Small 

(or slightly reduced) 

see whether there are any alterations of 
their amplitude (Fig. 15). The tests 
are then repeated following "tensilon" 
(edrophonium chloride). 



NORMAL 



M.G. 



M.S. 



3/sec 
for 1-5 sec 



IX FALL IN AMPLITUDE 
OF THE MUP AT 2SD. 



MORE THAN 7% FALL IN 
AMPLITUDE OF THE MUP. 



POSSIBLE RISE IN 
AMPLITUDE OF THE MUP 



30/sec 
for 1-5sec 






40% FALL IN AMPLITUDE 
OF THE >rUP AT 2SD.* 



MORE THAN 40% FALL IN 
AMPLITUDE OF THE MUP.* 



1007= RISE IN AMPLITUDE 
OF THE MUP. 



a. and b. after 
tensilon 



RETURNS TO NORMAL. 



LITTLE EFFECT. 



Fig. 15 



46 



Volume 56, No. 2 



The response in normal patients and 
in patients with myasthenia is variable 
at faster rates of stimulation. An initial 
rise of up to 10% or a fall may occur 

5. Paired stimuli 



in normal persons although eventually 
there is a decrement. In myasthenia 
gravis a variable rise or fall of ampli- 
tude may occur at 30 stimuli per 
second. 



2-5 msec. 



200 



SECOND 

RESPONSE 

AS A 7o OF 100 

THE FIRST 

RESPONSE. 




20 msec. 



^ 



lOsec, 



'NORMAL 



10^ 



10- 



10^ 



,10 



hOC-^ INTERVAL BETWEEN STIMULI, MSEC. 



Fig. 16 



Characteristic curves may be obtained 
for each of these groups (Fig. 16). A 
conditioning stimulus is applied to peri- 
pheral nerve and amplitude of the evoked 
MUP is measured. Paired stimuli are 
then applied to the nerve at increasing 
intervals of time. The amplitude of the 
second of each pair of stimuli is measured 



as a per cent of the conditioning stimulus. 
The responses of MUP's to paired 
stimuli and to repetitive stimuli at slow 
rates are probably the best means for 
electrodiagnosis of and for differentiation 
between normal persons, patients with 
myasthenia gravis and the myasthenic 
syndrome. 



April. 1971 



47 



Dr. I rank Keinble was graduated 
from Manchester University in England. 
He trained initially in Internal Medi- 
cine, then in Electromyography and later 
in Neurology. Dr. Kemble, who has been 
in the Department of Neurology at the 
University of Maryland School of Medi- 
cine three years, was Chief Resident 
1969-70 and is now working as a Clinical 
Fellow. His special interest is in neuro- 
muscular diseases and in the clinical 
applications of neurophysiology. 



{ 



1 




Conclusion 

The electrodiagnostic procedures de- 
scribed in this article help to differentiate 
neuromuscular diseases when clinical 



evaluation is difficult. They should always 
be used in conjunction with clinical, histo- 
logical and biochemical evidence in order 
to fully differentiate the patient's disorder. 



REFERENCES 



1. Buchthal. F. and Rosenfalk, A.: Evoked 
potentials and conduction in human sensory 
nerves. Brain Res. 3, No. 1, 1966. 

2. Kemble, F. and Peiris, O. A.: General ob- 
servations on Sensory Conduction in the 
normal adult median nerve. Electromyographv 
7: p. 127-140, 1967. 

3. Kemble, F.: Conduction in the normal 
adult median nerve: The different effect of 
aging in men and women. Electromyography 
7: p. 275-288, 1967. 

4. Mayer, R. F. and Mawdsley, C: Studies 
in man and cat of the significance of the 
H wave. J. Neuol.. Neurosurg. and Psychiat , 
Vol. 28, p. 201-211, 1965. 

5. Mayer, R. F. and Mawdsley C: Nerve 



conduction in alcoholic polyneuropathy. Brain, 
Vol. 88, Part II, p. 335-356, 1965. 

6. Mayer, R. F.: Peripheral nerve function 
in Vitamin B-12 deficiency. Arch. Neurol., Vol. 
13. p. 355-361. 1965. 

7. Kemble, F.: Electrodiagnosis of the carpal 
tunnel syndrome. J. Neurol., Neurosurg., 
Psychiat., Vol. 31, p. 23, 1968. 

8. Taverner, D. and Kemble, F., and Cohen, 
S. B.: Prognosis and treatment of idiopathic 
facial (Bell's) Palsy. Brit. Med. J. 4, p. 581- 
572. 1967. 

9. Lambert, E. H.: Defects of neuromuscular 
transmission in syndromes other than myas- 
thenia gravis. Ann. N. Y. Acad. Sci., 135, Art. 
1, p. 367. 



48 



Volume 56, No. 2 




MEDICAL SCHOOL SECTION 



Dear Alumni and Friends of the Medical School: 

The financial crisis that exists in most American medical 
schools is now receiving national attention. Hardly a week 
passes without mention of it in the news media and frequent 
reference to the situation occurs in the legislative bodies of 
our states and in Washington. The crisis has been precipitated by both a 
cutback in federal funding and by a change in the federal priorities regarding 
how federal funds are to be spent in the health area. 

For the past 20 years medical education has increasingly been financed 
indirectly. Financed indirectly via the support of biomedical research. Whether 
or not this approach to funding was sound need not concern us here. What 
must concern us is that federal biomedical research funds have permitted 
medical schools to expand into new programs, have catalyzed a rise in 
quality of medical education and have permitted the development of academic 
medical centers which are very important to our society. They did this by 
providing support for individuals not only involved in research but also 
involved in teaching and patient care. 

The crisis is magnified by its timing. It is hitting medical schools at a time 
when multiple new demands are being placed upon them. Demands to increase 
class size, to increase the admission rate of socioeconomically deprived students, 
to involve ourselves in meeting the needs of our surrounding communities, 
and to help approach the overall problems facing our country in the organi- 
zation and delivery of health care. The schools stand ready to move forward 
in each of these areas but they cannot move without support. 

The situation at our school is doubly difficult. We are being hit hard by the 
federal cutbacks while we continue to suffer from less than adequate state 
support. The medical school will not be in a position to meet the multiple 
demands that so desperately require attention, unless both the state and 
federal support improve, improve quickly and significantly. I would encourage 
all alumni to bring the current financial plight of medical education to the 
attention of as many people as possible in the hope that the message will reach 
those who have the power to correct it. 

Sinfiereb: yours 




/John H. Moxley III 
Dean 




April, 1971 



Faculty Appointments and Promotions 



Dean John H. Moxley has announced the 
following faculty promotions and appoint- 
ments in the School of Medicine through 
January 1971. 

Dr. Leeds E. Katzen has been appointed 
Director of Medical Education in Ophthal- 
mology — Mercy Hospital. Mrs. Rachel Booth 

is now Associate Director, Ambulatory Care 
Nursing. 

Appointed Professor were: Dr. Franklin 
L. Angell, Radiology; Dr. Eugene Rosem- 
berg, Pediatrics; Dr. Felix Heald, Pediatrics, 
and Dr. Gardner Smith, Surgery (Baltimore 
City Hospital). 

Promoted to the rank of Associate Pro- 
fessor were: Dr. Irving I. Kessler, Pre- 
ventive Medicine; Dr. Genevieve M. Mata- 
noski, Preventive Medicine; Dr. Lewis H. 
Kuller, Preventive Medicine, and Dr. 
Sheldon E. Greisman, Physiology. Associate 
Professor appointments include: Dr. Ira 
Wexler, Neurology; Dr. Richard A. Currie, 
Surgery; Dr. Peter Chodoflf, Anesthesiology, 
and Dr. Daniel S. Ruchkin, Physiology & 
Computer Science Center. 

Mr. Otto Payton was named Assistant 
Professor and Acting Head of Physical 
Therapy. 

Promoted to Assistant Professor were: 
Dr. William D. Lynn, Surgery; Dr. Arthur 
\. Serpick, Medicine; Dr. Pradman K. 
Qusba, Pharmacology; Dr. Donald H. Dembo, 
Medicine, and Dr. Misbah Khan, Pediatrics. 
Appointed Assistant Professor were: Dr. 
Robert M. Beazley, Surgery; Dr. Willy N. 
Pachas, Medicine; Dr. Eleanor Jantz, Psy- 
chiatry; Dr. Willem Bosma, Psychiatry; Dr. 
Brigita M. Krompholz, Preventive Medicine; 
Dr. Robert W. Sherwin, Preventive Medi- 
cine; Dr. Clarence W. Hardiman, Physical 
Therapy; Dr. Edward C. Knoblock, Medicine; 
Dr. Magdi G. Henein, Surgery; Dr. Gary 
Nobel, Surgery; Dr. James E. Olsson, Clinical 



Pathology; Dr. Lorence A. Gutterman, Medi- 
cine; Dr. Sidney Marks, Surgery; Dr. Wolf- 
gang J. Mergner, Pathology; Dr. Nathan B. 
Hyman, Radiology; Dr. Ranier M. E. Engel, 
Surgery, and Dr. Herbert Schwartz, Surgery. 

Dr. Frederick J. Balsam, Rehabilitation 
Medicine, and Dr. Sheppard Kaplow, Anes- 
thesiology, were promoted to Assistant 
Clinical Professor. 

New Instructors include: Dr. Perry Austin, 
Medicine; Dr. Young Chun, Medicine; Dr. 
Kenneth Gray, Medicine; Dr. Bruce T. Brian, 
Medicine; Miss Barbara Fleming, Psychiatric 
Social Work; Mr. Robert Ude, Physical 
Therapy/ Anatomy; Mrs. Judy Waldman, 
Psychiatric Social Work; Dr. Allan T. Leffler 
III, Pediatrics; Dr. Sylvester Steriofif, 
Surgery; Dr. Henry R, Herbert, Preventive 
Medicine; Dr. Simon C. Beaudet, Rehabili- 
tation Medicine; Dr. Larry A. Snyder, Radi- 
ology; Dr. Samuel Andelman, Radiology; 
Dr. Edwin J. Goldman, Anesthesiology; Dr. 
Robert Hoffenberg, Anesthesiology; Dr. Cecil 
B. Calderon, Pathology, and Dr. Edward W. 
Stockblower, Rehabilitation Medicine. 

Clinical Instructors are: Dr. Martin L. 
Lipson, Ophthalmology; Dr. Andrew D. 
Logue, Psychiatry, and Dr. Patricia N. 
Carver, Psychiatry. 

Mr. Joseph J. Dombrowski has been named 
research associate in Pharmacology; Dr. 
Mitsuhiro Yanagida in Biochemistry; Mrs. 
Joan M. Starr, Psychiatry; Dr. Kaumo U. 
Laiho, Pathology; Dr. Henry Joseph 
Wehman, Pediatrics; Mr. Robert E. Pender- 
grass. Pathology; Dr. Joseph E. McDade, 
Microbiology; Mrs. Mary Smith, Pathology; 
Mrs. Jane Dees, Pathology, and Dr. V. S. 
Sethi, Pharmacology. 

Dr. Belur S. Bhagavan is a Visiting As- 
sistant Professor and Visiting Clinical As- 
sistant Professors are Dr. Victor A. Frazekas 
and Dr. Andrew J. Saladino, both in Path- 
ology. 



Volume 56, No. 2 



^ 




^^MkA.! / .^: 



ALUMM ASSOCIATION SECTION 



President's Letter 



OFFICERS 



President 

Theodore Kardash, M.D. 



Dear Fellow Alumni, 



President-Elect 

Edward F. Cotter, M.D. 

Vice-Presidents 

Irving Burka, M.D. 
John C. Hamrick, M.D. 

Benjamin M. Stein, M.D. 

Secretary 

Robert B. Goldstein, M.D. 

Treasurer 

Arlie R. Mansberger, M.D. 

Executive Director 

William H. Triplett, M.D. 

Executive Administrator 

Francis W. O'Brien 

Executive Secretary 

Louise P. Girkin 

Members of Board 

Martin E. Strobel, M.D. 
Henry H. Startzman, Jr., M.D. 
Kyle Y. Swisher, Jr., M.D. 
William J. R. Dunseath, M.D. 
William H. Mosberg, Jr., M.D. 
Charles E. Shaw, M.D. 
Joan Raskin, M.D. 
Donald T. Lewers, M.D. 
Cliff Ratliff, M.D. 

Ex-oflficio Members 
Board of Directors 

Lewis P. Gundry, M.D. 

Wilfred H. Townshend, Jr., M.D. 

John H. Moxley, III, M.D. 



My year as President of the Medical Alumni Association 
passed very quickly. It appears that as President you just 
about become familiar with the office when it is time to 
depart. I have sincerely enjoyed my year as President, and 
I wish at this time to express my gratitude to the officers 
and Board of Directors of the Medical Alumni Association 
and to all who have so willingly helped when called upon 
to work within the year. I especially wish to commend the 
Davidge Hall Restoration Committee and the committee who 
will select a nominee for our annual Gold Key Award. I 
also wish to congratulate Dr. Edward F. Cotter, my friend and 
associate for many years, on his pending year of office as 
President of the Medical Alumni Association. 

Final plans for Alumni Day, June 3, 1971, appear in 
another section of this Bulletin. 

It has been an honor and a pleasure to serve as your 
President and I look forward to continue to serve as ex-officio 
for the next two years. 



Sincerely, 




Theodore Kardash, M.D? 

President 

Medical Alumni Association 



April, 1971 



50 Year Graduates 



Bruce Barnes. M.D. 
107 Pine St., 
Seaford. Del. 19973 

Carl Fisher Benson, M.D. 
5111 YorkRd., 
Baltimore. Md. 21212 

John R. Bernardo, M.D. 
198 High St., 
Bristol, R. I. 02809 

Vincent Bonfiglia, M.D. 
4010 W. 21st St., 
Los Angeles, Calif. 90018 

Earl E. Broadrup, M.D. 
Park Terrace, Apt. B36, 
Aberdeen, Md. 21001 

Oscar Costa-Mandry, M.D. 
1613 Sta Bibiana, 
Rio Piedras, P. R. 00926 

Samuel H. Culver, M.D. 
2308 South Rd., 
Baltimore, Md. 21209 

Herman J. Dorf, M.D. 
7404 Liberty Rd., 
Baltimore. Md. 21207 



Charles F. Fisher, M.D. 

321 W. Main St., 

Clarksburg, W. Va. 26301 

Waynesboro, Pa. 17268 
John W. Guyton, M.D. 

c/o W. L. Guyton, 

130W. Main St., 
Albert Jaffe, M.D. 

130Slade Ave., 

Baltimore, Md. 21208 
George R. Joyner, M.D. 

133 Chestnut St., 

Suffolk, Va. 23434 
Frank A. Pacienza, M.D. 

700 N. Charles St., 

Baltimore, Md. 21201 

Moses Paulson, M.D. 
1 1 E. Chase St., 
Baltimore, Md. 21218 

Edgar A. P. Peters, M.D. 
394 Bergen Ave., 
Jersey City, N. J. 07304 

Jos. POKORNY, M.D. 

2200 E. Madison St., 
Baltimore, Md. 21205 



Francis A. Reynolds, M.D. 
43 Cottage St., 
Athol, Mass. 01331 

Harold A. Romilly, M.D. 
16701 Seneca Ave., 
Lakewood, Ohio 44107 

Louis M. Timko, M.D. 
3015 Ripley Rd., 
Cleveland, Ohio 44 120 

Herman E. Wangler, M.D. 
616 S.E. 18th St., 
Ft. Lauderdale, Fla. 33316 

George E. Wells, M.D. 
4100 Edmondson Ave., 
Baltimore, Md. 21229 

William F. Weinkauf, M.D. 
Corunna, Mich. 48817 

Mortimer H. Williams, M.D. 
711 Med. Arts Bldg., 
Roanoke, Va. 24011 



ALUMNI DAY CLASS CAPTAINS 

1921 Moses Paulson, M.D. 

1926 Walter C. Merkel, M.D. 

1931 Emmanuel A. Schuminek, M.D. 

1936 Gibson J. Wells, M.D. 

1941 PiERSON M. Checket, M.D. 

1946 James A. Roberts, M.D. 

1951 William G. Esmond, M.D. 

1956 G. Edward Reahl, Jr., M.D. 

1961 Francis A. Clark, Jr., M.D. 

1966 Richard M. Susel, M.D. 

Members of the Class 1921 will be 
honored guests at the Alumni banquet and 
will receive their certificates of a half cen- 
tury of service from the President of the 
Medical Alumni Association. 



Volume 56, No. 2 




CLASS OF 1913 
Dr. Charles L. Mowrer, 159 W. Washing- 
ton St., Hagerstown, Md., died October 8, 
1970. 

CLASS OF 1913 BMC 
Dr. George Pines, 240 S. LaCienga Blvd., 
Beverly Hills, Calif., died December 26, 
1970. 

CLASS OF 1916 
Dr. William T. Ferneyhough, 719 S. Main 
St., Reidsville, N. C. died recently. 

CLASS OF 1918 
Dr. Harley M. Johnson, Box 87, West 
Columbia, S. C, died recently. 

CLASS OF 1919 
Dr. John W. Kellam, Jamesville, Belle 
Haven, Va., died June 14, 1970. 



CLASS OF 1924 
Dr. Joseph G. Miller, 107 W. Saratoga 
St., Baltimore, Md., died October 31, 1970. 

CLASS OF 1928 
Dr. A. L Grollman, 19 Garfield Place, 
Cincinnati, Ohio, died recently. 

CLASS OF 1929 
Dr. Saul Schwartzbach, 1726 Eye St., 
Washington, D. C, died November 1, 1970. 

CLASS OF 1934 
Dr. Edward S. Hoffman, 7 Brookside Dr., 
Rochester, N. Y., died December 25, 1970. 

CLASS OF 1964 
Dr. Charles H. Asplen, Peter Bent Brigham 
Hospital, Boston, died January 30, 1971 at 
age 38. 



April, 1971 



ALUMNI NEWS REPORT 



TO THE BULLETIN: 



I would like to report the following: 



SUGGESTIONS FOR NEWS ITEMS 

American Board Certification 
Change of Address 
Change of Office 
Residency Appointment 
Research Completed 
News of Another Alumnus 
Academic Appointment 
Interesting Historic Photographs 



Name_ 



Address^ 



Class- 



Send to 



Dr. John A. Wagner, Editor 
Bulletin — School of Medicine 
University of Maryland 
31 S. Greene St. 
Baltimore, Md. 21201 

Volume 56, No. 2 




TAYLOR MANOR HOSPITAL 

For Psychiatric Diagnosis and Treatment 



IRVING J. TAYLOR, M.D. 
MEDICAL DIRECTOR 



ELLICOTT CITY. MD. 

PHONE: HO 5-3322 



Support 

Davidge Hall 
Restoration 

Fund 



The 

John D. Lucas Printing Co. 

26th & SissoN Streets 

Baltimore, Maryland 21211 

Phones: BElmont 5-8600-01-02 



Symbols in a life of 
psychic tension 

Iwla t%m 
class of '66 

Ph.D. 

thesis ... in progress 

series and complete 
examination normal 

(persistent indigestion) 



Valium^ 

(diazepam) 

2-mg, 5-mg, 10-mg tablets 
t.i.d. and h.s. 

for relief of psychic 

tension and resultant 

somatic symptoms 

within the first day 

for some patients 

Before prescribing, please consult 
complete product information, a 
summary of which follows: 
Indications: Tension and anxiety 
states; somatic complaints which are 
concomitants of emotional factors; 
psychoneurotic states manifested by 
tension, anxiety, apprehension, 
fatigue, depressive symptoms or 
agitation; acute agitation, tremor, 
delirium tremens and hallucinosis 
due to acute alcohol withdrawal; ad- 
junctively in skeletal muscle spasm 
due to reflex spasm to local pathol- 
ogy, spasticity caused by upper 
motor neuron disorders, athetosis, 
stiff-man syndrome, convulsive 
disorders (not for sole therapy). 
Contraindicated: Known hypersensi- 
tivity to the drug. Children under 6 
months of age. Acute narrow angle 
glaucoma. 

Warnings: Not of value in psychotic 
patients. Caution against hazardous 
occupations requiring complete 
mental alertness. When used ad- 
junctively in convulsive disorders, 




possibility of increase in frequency 
and/or severity of grand mat seizures 
may require increased dosage of 
standard anticonvulsant medication; 
abrupt withdrawal may be associated 
with temporary increase in frequency 
and/ or severity of seizures. Advise 
against simultaneous ingestion of 
alcohol and other CNS depressants. 
Withdrawal symptoms have occurred 
following abrupt discontinuance. 
Keep addiction-prone individuals 
under careful surveillance because of 
their predisposition to habituation 
and dependence. In pregnancy, lac- 
tation or women of childbearing age, 
weigh potential benefit against pos- 
sible hazard. 

Precautions: If combined with other 
psychotropics or anticonvulsants, 
consider carefully pharmacology of 
agents employed. Usual precautions 
indicated in patients severely de- 
pressed, or with latent depression, 
or with suicidal tendencies. Observe 
usual precautions in impaired renal 
or hepatic function. Limit dosage to 



smallest effective amount in elderly 
and debilitated to preclude ataxia or 
oversedation. 

Side Effects: Drowsiness, confusion, 
diplopia, hypotension, changes in 
libido, nausea, fatigue, depression, 
dysarthria, jaundice, skin rash, 
ataxia, constipation, headache, in- 
continence, changes in salivation, 
slurred speech, tremor, vertigo, 
urinary retention, blurred vision. 
Paradoxical reactions such as acute 
hyperexcited states, anxiety, halluci- 
nations, increased muscle spasticity, 
insomnia, rage, sleep disturbances, 
stimulation, have been reported; 
should these occur, discontinue 
drug. Isolated reports of neutropenia, 
jaundice; periodic blood counts and 
liver function tests advisable during 
long-term therapy. 



Roche 

LABORATORIES 

Division of Hof(mann-La Roche Inc. 
Nutley, New Jersey 07110 



John A. Wagner, B.S., M.D. 
Chief Edit " 

Jan K. Walk 

Managing Edit 



editorial boar 

George Entwisle, B.S., M.L, 

Robert B. Goldstein, JVI.C 

John C. Krantz, Jr., Sc.D., PhX 

Arlie Mansberger, M.C 

William H. Mosberg, B.S., M.C 

Francis W. O'Brie 

John H. Moxley, III, M.tl 
(ex-officil 

Edward F. Cottc 
ex-offici 




Left — Ceiling of 
Anatomical Hall gives the illusion of 
being coffered by the decorative 
plasterwork which has rosettes of 
of anthemion, circles, semicircles and 
filler lozenges. Right — Ehler's wood- 
cut of Davidge Hall as it appeared 
in 1873. 



BulLetin 



PUBLISHED FOUR TIMES A YEAR, JANUARY, APRIL, 
JULY AND OCTOBER JOINTLY BY THE FACULTY OF 
THE SCHOOL OF MEDICINE OF THE UNIVERSITY OF 
MARYLAND AND THE MEDICAL ALUMNI ASSOCIATION. 



Davidge Hall Bryden B. Hyde, A.I.A. 

Potpourri 

Folk Medicine in Maryland George G. Carey, Ph.D. 

Black Physicians Emerson C. Walden, M.D. 

Nutrition of Children in Developing Countries 
Barbara Underwood, M.D. 

Dean's Thoughts 

Internship List 1971-72 

Ambulatory Health William S. Spicer Jr., M.D. 

Professors of Surgery 1807-1970 Harry C. Hull, M.D. 

Alcoholism in Maryland Willem G. A. Bosma, M.D. 

Alumni Day-Graduation 1971 

Alumni Activities 



1 
9 
12 
16 

19 
23 
24 
30 
34 
43 
46 
58 



Second class mailing privilege authorized at Baltimore, Maryland 




davidge hall 



Bryden B. Hyde 



Rich in tradition and virtually un- 
changed in its fabric, Davidge Hail is 
rapidly becoming more appreciated as 
an integral part of the American medi- 
cal heritage. 

The original Davidge Hall was razed 
some ten years ago to make space for 
the Health Sciences Library. The brick 
structure had perhaps the largest 
double-hung sash window in Baltimore 
with its 36 large panes or "lights." A 
fire insurance policy dated February 
20, 1824 issued by the Baltimore Equit- 
able Society (1794) describes the edi- 
fice: 

To the University of Maryland, upon 
the brick building fronting on the 
south side of Lombard Street near the 
west side of Greene Street sixty feet 
and extending back forty feet, being 
four stories including basement story. 
Also three-story brick stairway at 
the back part thereof seventeen feet 
by twenty feet also three-story build- 
ing at the south end of said stairway 
thirty-six feet square, the whole plan 
finished having brick cornice. 



From the architectural historians' and 
preservationists' viewpoint, the loss of 
the original Davidge Hall is great. This 
indicates the need to preserve and 
recondition the present Davidge Hall, 
which was renamed from "The Medical 
College" or "College Building," to 
honor Dr. John B. Davidge, who was 
largely responsible for its construction 
in 1812. 

HISTORY 

The Baltimore physicians organized 
themselves into the Medical Society of 
Baltimore around 1789 and elected 
officers. These doctors at the time were 
giving lectures on anatomy, the theory 
and practice of physic, surgery and 
chemistry in their homes. 

Around 1800, Dr. John B. Davidge, 
who was educated in Europe, delivered 
lectures on the principle and practices 
of midwifery, and then added practical 
surgery and demonstrative anatomy. 
Even though less than a dozen students 
attended his lectures. Dr. Davidge built 



Editor's Note: Davidge Hall is the oldest medical school building in the nation. It is noted for a unique, 
classical appearance which typifies the period of classical revival during which it was built. Bryden B. 
Hyde, A. I. A., a Baltimore architect, describes the historic edifice in architectural terms and tells why 
and how the building was built. His expertise was sought in planning for the restoration of Davidge Hall 
and the eventual designation of the structure among sites of national historic interest. 



an anatomical hall near the southeast 
corner of Liberty and Saratoga streets 
and was joined by Dr. John Shaw, who 
gave lectures on chemistry. The ana- 
tomical lectures were short-lived as the 
building was demolished by the popu- 
lace and what was described as "ig- 
norant neighbors." For the next two to 
three years, the anatomical and surgi- 
cal lectures were delivered in the 
county almshouse. 

It was preventive medicine, perhaps, 
that first aroused the interest of the 
Maryland Legislature in the teaching of 
Medicine. Inoculation against smallpox 
was introduced into the area by Dr. 
James Smith. Upon Dr. Smith's applica- 
tion, the Maryland Legislature became 
the first to sanction distribution of the 
vaccine. In 1809, he was granted a lot- 
tery to raise money for the distribution 
of the vaccine free for six years. 

Anxious to establish medical educa- 
tion upon a firm basis, and to afford it 
the protection of the law, Drs. Davidge, 
Shaw and Cocke applied to the legisla- 
ture for the privilege of establishing a 
college and on January 20, 1808 an act 
was passed by the General Assembly. 
The following appeared in the History 
of Baltimore City and County, Maryland: 
. . . for founding a medical college in 
the city or precincts of Baltimore for 
instruction of students in the different 
branches of medicine . . . by the name 
of the College of f^edicine in Mary- 
land. 

The faculty as suggested by the peti- 
tioners was included within the act. At 
the same time John Eager Howard, 
James McHenry, James Calhoun, 
Charles Ridgely of Hampton, William 
Gwynn, John Comegys, Charles A. 
Warfield, John Crawford, Soloman Burk- 
head, John Beale Davidge and Ennals 
Martin were appointed commissioners 
and authorized to propose a lottery 
scheme for raising an amount not ex- 
ceeding $40,000 for the college's use. 

However, the lottery was not held. 
Destitute of everything but an enthusi- 
astic spirit, and without a place to 
accommodate a class, the faculty lec- 
tured in their own dwellings to the first 
class of seven pupils. An old frame 
schoolhouse was used for anatomy 
classes and found to be so cold that 
the professor's subjects were frozen. 



During the winter of 1809-10 a ballroom 
on Commerce St. near Exchange Place 
was allowed to be used by its owner, 
Mr. Mallet, between the hours 12-2 p.m. 
The class increased to 18 and in April 
1810 the first degrees of Doctor of 
Medicine were conferred on five candi- 
dates. Determined to start operations 
on their own credit and responsibility, 
the managers of the college secured a 
lot from John E. Howard on the north- 
east corner of Lombard and Greene 
streets where they proceeded to build 
the needed structures. 




Dr. Davidge was selected as the first 
dean of the school and under his 
leadership a new concept of medical 
education was formed: "The science of 
medicine could not be successfully 
taught under the usual organization of 
medical schools; that without the aids 
of physiology and pathology, either 
associated with anatomy or as a sep- 
arate chair institutes, the philosophy of 
the body of sickness or in health could 
not be understood." 



THE ARCHITECT 

Robert Carey Long Sr. (1770-1833), 
the architect selected for Davidge Hall, 
is often confused with his son, Robert 
Carey Long Jr., also an excellent archi- 
tect. Unlike his son who started his 
career as an architect, the senior Long 
worked his way up and became the 
leading Baltimore-born architect of the 
19th century. In the city directories 
from 1796-1823 he lists himself as a 
carpenter, in 1824 as an architect and 



in 1833 as architect and engineer. He 
was a carpenter-builder when there 
were no architects in town. 

In 1798, Long and three others built 
the Assembly Room at the northeast 
corner of Fayette and Holliday streets 
from a design by Col. Nicholas Rogers. 
Next Long became associated with the 
architects B. F. Latrobe, Maximilen 
Godefroy and Robert Mills. Godefroy, 
who was trained in France, had much 
sought architectural books that weren't 
readily available to all architectural 
students. Long worked with him on St. 
Mary's Seminary Chapel which was de- 
signed in 1807 and completed in 1808. 
The Bank of Pennsylvania built in 1797 
and designed by Latrobe along a Pan- 
theon scheme also influenced Long. 
Latrobe's designs for the Roman Cath- 
olic Cathedral (1808) had an impression 
on Long, particularly the dome with the 
central skylight which was designed, 
but not built. 

In turn, Robert Mills was probably 
influenced by Long's Davidge Hall dome 
and skylight when he designed the First 
Baptist Church in 1817. The church 
which was demolished in 1878 had a 
"lantern" skylight with vertical windows 
around it. And, Godefroy was influenced 
by Long's dome as shown by his sky- 
light on the First Unitarian Church built 
in 1817 which was quite similar to the 
segmentally glazed one on Davidge 
Hall. 

When Long designed the Union Bank 
in 1807, he drew upon a recent English 
publication to update the traditional 
square brick structure. He included 
such devices as the recessed vestibule 
with colonnade screen, the arched re- 
cesses with windows and the sculptured 
panels and pediment now located in 
the Peale Museum garden. 




Robert Carey Long, Sr. was an hon- 
orary member of the National Academy 
of Design, New York, and exhibited 
architectural designs there 1827-28. He 
also did water colors and one of Mt. 
Vernon Place (1829) is in the Maryland 
Historical Society collection. He be- 
came the patron of Signer Capellano as 
sculptor of several panels on St. Paul's 
Church in 1815. As a patriot he offered 
his services along with his 30 carpen- 
ters in the defense of Baltimore in 1814. 
They were the only men who functioned 
as a unit in building the fortifications for 
the city. 

Long moved from Conowago St. (now 
Lexington St.) near Charles to 16 W. 
Hamilton (Hamilton St. Club) before 
1824. He built and owned this row of 
houses. Except for Davidge Hall and 
the Peale Museum (1813), these are the 
only vestiges of the "vast number of 
edifices both public and private" for 
which Long was architect. 

His Holliday Street theatre (1813) 
also built by Col. James Mosher, his 
masterpiece, St. Paul's Church (1817) 
in the Greek Doric Order which cost 
$126,000, the City Jail (1800), "Calver- 
ton" Alms House (1822), Robert Oliver's 
resident "Greenmount," and William 
Gwynn's residence "Tusculum" (1823) 
which was located behind Barnum's 
Hotel, have all disappeared, at a great 
historic and architectural loss to Balti- 
more. 

Long died in February 1833. 

THE BUILDERS 

Records show that Messers. Towson 
and Mosher were the builders of 
Davidge Hall. Thomas Towson, a stone- 
mason, or Henry Towson, a carpenter, 
may have been referred to. Col. James 
Mosher, who started as a bricklayer, 
built many of the better buildings at that 
time. The whereabouts of the corner- 
stone, which was laid May 7, 1812 by 
Col. Howard, is a mystery. The building 
was "partly tenantable" by October 1812. 

DAVIDGE HALL 

Over the main entrance door still 
hangs the wooden gilt and black 
"clasped hands" fire insurance policy 
sign No. 7791 of the Baltimore Equit- 
able Society. The $12,000 policy de- 



scription dated November 15, 1823 

reads: 

To the University of Maryland upon 
their brick l\/ledical College, fronting 
on the north side of Lombard near 
the east side of Greene Street 63 feet 
and extending back 93 feet one story 
high with large dome thereon and 
portico in front 10 feet wide with 
eight stone pillars to support the 
same conveniently laid off and fin- 
ished for said purpose. 




It is of interest that on the same day 
another insurance policy by Baltimore 
Equitable for $2,000 was issued for the 
building now known as Gray labora- 
tory: 

To the University of Maryland upon 
their brick building near the northeast 
side of the Medical College, being 
sixty-four feet by thirty-four feet oc- 
cupied for a medical museum two 
high stories. Plain finished for said 
purpose having a brick cornice. 
The prospects of the institution 
began to improve during this period, 
and the medical class increased in num- 
bers yearly until in 1825 it numbered 
300. In the meantime, "Practice Hall" 
and the Baltimore Infirmary had been 
created, and a museum established by 
the purchase of a valuable pathological 
collection of Professor Allen Burns of 
Glasgow, Scotland. 

,i^'"'' """^■, 



•* • ■' 
I II I I I 




The earliest representation of Dav- 
idge Hall known is an engraving taken 
from the border of Poppleton's Map of 
1820. "After Parthenon of Athens" 
should read "After Pantheon in Rome." 
An interesting question for historians to 
consider is, "Why was a $200,000 build- 
ing only insured for $12,000?" The en- 
graving shows how little the building 
has changed since being built. 

The design used by Long for Davidge 
Hall is described in The Architecture of 
Baltimore by Howland and Spencer: 




,.^|K'^^" 



The design is a bold one with little 
precedent in American architecture. 
The main room is a circular ana- 
tomical theater (Anatomical Hall), 
roofed by a wooden dome. Below is 
a room of the same diameter, sixty 
feet, originally used for the Chemical 
Hall. A section with offices and a li- 
brary, in conveniently rectangular 
rooms, is added to the front of the 
lecture room, between this part of the 
composition and the porch. The ex- 
terior reveals nothing of the fact that 
the main room is round, except for 
the very low dome rising above a 
high drum. Long's building . . . is one 
of the first Pantheon schemes in this 
country . . . In some details Long 
shows himself to be a very provincial 



architect; there is much wasted space 
in the interior, particularly at the junc- 
tion of the curved theatre and the 
outside walls; the portico is wide for 
its height; the wooden facade at- 
I tached to the brick building presents 
a barren appearance with little appro- 
priate ornamentation. Perhaps this 
latter drawback was dictated by 
economy rather than the architect's 
taste, for Long would have known that 
the Doric Order carries metopes and 
triglyphs. 

Long demonstrated with the Union 
Bank his ability to handle an elaborate 
design including sculpture, and it is 
said that he intended the long recessed 
panel high in the portico wall to receive 
a relief sculpture eventually. Although 
spaces between circles and squares are 
generally wasted in order to gain dra- 
matic effect, one wonders whether their 
original uses in Davidge Hall may not 
have justified them more. Cadavers in 
whisky barrels filled dark corners and 
a dissection could be performed in some 
obscure room unobserved by the public. 
Ghouls could secrete a freshly buried 
body from St. Paul's cemetery up Wine 
Alley through one of several rear doors 
into some odd-shaped space. 




The building is on a monumental 
scale and "in the spirit of simplicity 
exemplified by Mills." The walls of 
handmade bricks are laid up with fairly 
thin joints (three brick courses of eight 
inches as is standard today). The rear 
wall of the front portico is in the more 
formal Flemish Bond with alternate 
header (end) and stretcher (side) bricks 
in alternating courses. The other walls 
including the drum are in common 
bond: five stretcher courses are bonded 
by the sixth course of headers. Paver 
brick in a herringbone pattern were laid 
in sand in the portico floor which has a 
granite curbing. 



hacL^ 




The exterior walls are generally 18 
inches of brick plus plaster on the 
inside face. Where the drum is tangent, 
the walls increase to 24 inches of brick 
plus plaster. 




The eight stone Doric columns of the 
portico have stone bases and taper to a 
smaller diameter at the cap. They are 
of four 60-inch high sections plus cap 
section, and although the stone has 
been painted — perhaps it is a rela- 
tively soft Aquia Creek sandstone — 
the joints can be seen. The window and 
door sills are made of this stone as is 
the collar under the lunette windows of 
the drum. 



The entablature is quite simple and is 
the unadorned pediment of narrow 
tongue and groove (or possibly shiplap) 
boards painted white with the columns. 





The entablature is carried along the 
sides with an "architectural break" in 
the wall expressing the square dome 
"base." Wood coping trim occurs above 
this on the three-stepped Neo-Greco 
pediments occurring on all four sides 




of the dome base. Large 33-pane fan- 
light windows are centered over the 
entablature in these pediments at the 




sides. On both side walls centered be- 
low this fan light is a large Palladian 
window with a narrow wooden frame 
which is recessed. Flanking the Pal- 
ladian window are a pair of 12-over-12 
double-hung sash windows with semi- 
circular headed frames which are filled, 
as the portico pediment, with horizontal 
tongue and groove boards. These also 
have 12-inch ground brick arches. First 
story windows toward the portico are 
the same size sash, but have flat brick 
arches. The second story windows are 
the same width, but have 8-over-8 lights. 



U". 



I-C 



rnrTri 

roafci 

rrc 
nrmn 







Around the dome drum are 16 regu- 
larly spaced lunettes with 12-inch brick 
arches. Most of these are "blind" and 




only every fourth one is a lunette-fan- 
light window hinged at the sill into 
Anatomical Hall providing both light 
and ventilation. Centered on line to the 
center of the dome and over every other 
one of these lunettes are eight skylights 
halfway up the dome, which has a three- 
stepped base. These square skylights 
conceal circular openings through the 
dome and add considerably to the light 
given by the 25 pie-shaped segments 




of the round central skylight. The 
copper-standing seam roof recently in- 
stalled duplicates the old tin roof and 
the seams all radiate from the center 
of the dome. The original roof of the 
dome was seen when the tin roof was 
removed exposing the wooden shingles 
laid over solid wood sheathing. The 
sheathing in turn was nailed to radiating 
wooden rafters. The roofing contractor, 
Nicholas Detorie, states that the con- 
struction of this dome and the upper 
dome of Godefroy's First Unitarian 
Church are similar. 

THE INTERIOR 

One enters the building through the 
large, original double doors, 3 feet wide 
by 12 feet high. The original box lock 
was stolen within the past five years, 
but the keeper is present on the right 
door. The floor, now terrazzo, was orig- 
inally wood, brick, or square gray and 
black marble on a diagonal. Doors off 
the entry lead to adjacent offices. 





A contemporary and excellent 
wooden bust of Dr. John B. Davidge, 
probably by William Rush, is in the 
entry on a pedestal in a shallow stove- 
niche and quite unprotected. Above 
and to the left of the bust is an original 
clock face with the works missing. To 
the right, the L-shaped hall leads to a 
long flight of 21 stairs. The wooden 
treads have been replaced as well as 
the scrolled step-end brackets. The out- 
line of the originals, differing in shape 
from the replacements, can be seen 
outlined in the old paint. 

Past the staircase, the corridor leads 
to the circular "Chemical Hall" which 
is on the ground level. It has a later 
herringbone brick floor. (There are 
rumors, but no evidence of a part base- 
ment). At the top of the stair, a corridor 
leads to the top of eight tiers upon 
which students are seated for lectures. 
The students look down on the rostrum 
and forward to a bowed classical 
procenium with niches, panels, and a 
shelf for statuary surrounding it. The 
procenium is closed now and conceals 
the six wrought iron doors, damper 
handles, etc., of the retorts where 
chemical demonstrations were made. 




7 



An office at the head of the stairs leads 
to the Faculty Alumni Lounge which has 
a barrel-vaulted ceiling and is parallel 
to the portico. The present ceiling is 
below the higher original ceiling. Be- 
yond the lounge area the Post Graduate 
office has steps which have been parti- 
tioned off and an arch and skylight can 
be seen. 

Around the back, in the northeast 
corner, a small wooden stair leads up 
the wall of all-header brick and curves 
on the inside of this corner only. An- 
cient anatomical drawings are displayed 
in the adjacent corridor. The pitched 
ceiling under the tiers of Anatomical 
Hall and above the steps leading to the 
hall is the original random width five- 
foot four-inch yellow pine tongue and 
groove floors with some exposed nail- 




• • 



• # 

Going up the main front stair, there 
is a carved skirting board adding a re- 
strained embellishment. This stair has 
also been partitioned off at the top. 
Here a two-panel door with original 
wishbone platelach can also be seen. 



ANATOMICAL HALL 

Upon entering the lowest level of 
Anatomical Hall, adjacent low doors 
permit access to the space between the 
floors and a view of the interesting 
framing which is heavy and sound. Four 
by four ceiling joists support hand-split 



lath and plaster of the flat ceiling of 
Chemical Hall below. Supporting these 
joists are paired 12' x 16' beams at 
approximately 1/3 points of the span of 
the drum. These beams are tied (with 
wrought iron) perpendicular to a pair 
of 12' x 16' beams and also tied at 1/3 
points of the span of the drum. Resting 
on this mesh are other beams which 
support the tier beams, radiating up- 
ward. 

The most exciting and inspiring 
space in Davidge Hall is the Anatomical 
Hall. Steps lead up at intervals to the 
tiers and the top walkway which has 
lunette windows on the floor and niches 
where coal stoves once stood on brick 
"hearth," their stacks passing through 
holes in the brick drum and out beyond 
the cornice. Fires were caused in sev- 
eral places and is evidenced by charred 
timbers. 

The ceiling gives the illusion of being 
coffered by the decorative plasterwork 
which has "rosettes" of anthemion, 
circles, semicircles and filler lozenges. 
Into this design the circular skylights 
find their places, the whole being 
beautifully crowned and lit by the huge 
central skylight. A chandelier (not the 
original) hangs in the center. 




LIGHTING 

Lighting was at first by oil lamps and 
soon after by gas, it appears. R. C. 
Long Sr. was one of the founders and 
secretary of the Baltimore Gas Com- 
pany in 1816. A piece of gas pipe, its 
age as yet unknown, exists in one of 
the side corridors. Rembrandt Peale 
was a pioneer in lighting by gas, and 
Long worked with him on it. 



pot pourri 

family practice 



Because of a growing student interest 
and concern over the future of a family 
practice program at University Hospital, 
the Student Council has provided $1,800 
for summer precepteeships. 

Dr. William Layman, associate direc- 
tor of the Division of Family Medicine, 
said the funds will be used to sponsor 
three students for eight weeks of study 
and work with private physicians. 

The stipends received by the students 
in the program vary between $600-$800 
and the degree of knowledge obtained 
by the students is as individualized as 
the physician working with the student 
doctor. 

Dr. Layman stated the purpose of the 
program as threefold: to interest the 
medical student in a career in Family 
Medicine; to influence his ultimate place 
of practice by exposing him to various 
locations in the state that are in need 
of physicians, and to involve the student 
in a research project in some aspect 
of the delivery of health care while he's 
out in the community. 

Participating in the program this sum- 
mer will be freshmen, sophomores 
and several juniors. Freshmen students 
are required to work in the Family Medi- 



cine unit for a week under Dr. Layman's 
direction before they begin their pre- 
cepteeship. Funding for the preceptee- 
ships has come from county medical 
societies, the Maryland Academy of 
Family Practice Physicians, private 
physicians as well as an outside busi- 
ness firm. Dr. Layman said that this 
summer the Board of Trustees of Wash- 
ington County Hospital, Hagerstown, 
Md., have voted to provide room and 
board for four students serving as 
preceptees. 

During the student's eight week clini- 
cal experience they will shadow their 
preceptor during office hours, attending 
medical meetings and participating 
after hours in emergencies and on 
house calls. Two of the students will 
also be participating in a study of the 
management of primary care problems 
in family practice and also the collec- 
tion of data on the attitudes of family 
physicians with respect to the use of 
physicians' assistants. 

Dr. Layman said, "Precepteeships are 
the oldest method of instruction for 
students. There is an interchange of 
ideas between the physician and the 
student and the student learns by doing 
— participating in examinations, emer- 
gencies, delivery, intensive care, etc. 
It's a one-to-one teaching experience." 



grant for genes study 



The John A. Hartford Foundation, 
Inc. of New York City has awarded a 
$293,340 grant to the University of Mary- 
land, School of Medicine for joint use 
by the Department of Cell Biology and 
Pharmacology and the Department of 
Pediatrics for research in the area of 
gene therapy. 

Funds will be used to implement the 
proposal entitled "The Use of DNA for 
Gene Therapy: Development of a New 
Treatment for Inherited Metabolic Dis- 
eases." The specifics of the research 
were stated by Dr. H. Vasken Aposhian, 
professor and chairman, Department of 
Cell Biology and Pharmacology, and Dr. 



Marvin Cornblath, professor and head, 
Department of Pediatrics, in seeking 
support from the Foundation as follows: 

"Significance of the proposed re- 
search: The possible recovery of the 
large number of future life years lost 
by birth defects and the possibility of 
providing a normal or improved life for 
patients with non-fatal inherited disease 
indicates there is a need for DNA as a 
therapeutic agent." 

Another important long range goal de- 
scribed in the research proposal which 
is of mutual interest of the two depart- 
ments, is the DNA treatment of insulin 
deficient juvenile diabetes. 



9 




division of respirat 



A division of Respiratory Care has 
been formally established within the 
Department of Anesthesiology by Fac- 
ulty Board approval after such a unit 
was operational for about a year. 

Dr. Martin I. Gold, medical director 
of the unit and professor, stated that 
the purpose of the unit is to function 
outside the operating room In contrast 
to the traditional function of an anes- 
thesiologist which operates inside the 
operating room. 

"Many patients in the hospital need 
various degrees of respiratory care. 
Some need oxygen, some need humidi- 
fication, some have tracheotomies, 
others have tubes in their mouth or 
noses leading to the windpipe . . . these 
patients require certain expertise," Dr. 
Gold explained. 

Patients presently requiring respi- 
rators or ventilators at University Hos- 
pital include a 14-year-old girl suffering 
from myasthenia gravis who developed 
breathing problems; bronchitis and 
emphysema cases; post-operative cases 
whose bandages and dressings make 
breathing difficult; pediatric cases in- 
cluding newborn infants, and an over- 
dosed narcotic addict. All need re- 
spiratory support. 

The service shall manage respiratory 
care of patients through the use of res- 
pirators or ventilators and through 




analytical technique such as taking ar- 
terial blood and measuring the blood 
gases which indicate the lungs are 
working with mechanical help. Adjust- 
ments are made according to the blood 
gas readings so that the respirator can 
be adjusted to fulfill the patients' needs. 

Currently, Dr. Gold has a resident 
and inhalation therapists assisting him 
in the program. He hopes that upon 
completion of the North Hospital a spe- 
cial respiratory intensive care unit will 
be available where only patients with 
respiratory problems would be located, 
not spread throughout the hospital as 
is currently the situation. 

"However, since this is not possible 
presently and the patients are still 
spread throughout the hospital, we 
hope that physicians and nurses can 
rotate through the division where they 
can learn techniques necessary to give 
the patient the best respiratory care 
available," said Dr. Gold. 

Maryland's Division of Respiratory 
Care is among the first to be set up 
across the nation. 



bressler fund committee grants 



The Bressler Fund Committee has ap- 
Droved $51,867 for research to be car- 
ded out in the Frank C. Bressler Re- 
search Laboratory. 

A trust fund established by the will 
3f the late Frank C. Bressler built and 
9quipped the laboratory and income 
from the fund makes possible monies 
3ach year for research to be carried 
out by departments and individuals who 
are located in the building. 

The following were approved to re- 
ceive funding: Joseph W. Burnett, M.D., 
Dermatology/Medicine, $3,500; Edward 
J. Donati, Ph.D., Anatomy, $950; Charles 



P. Barrett, Ph.D., Anatomy, $1,500; 
Stephen R. Max, Ph.D., Neurology, 
$6,905; Charles C. C. O'Morchoe, M.D., 
Anatomy, $3,700; A. H. Janoski, M.D., 
Endocrinology/Medicine, $2,512; 

Patricia J. O'Morchoe, M.D., Anat- 
omy, $4,000; Hugh G. Beebe, M.D., 
Surgery, $2,000; John G. Wiswell, M.D., 
Medicine, $1,200; Priscilla Oilman, M.D., 
Pediatrics, $3,000; Fima Lifshitz, M.D., 
Pediatrics, $3,000; J. Tyson Tildon, 
Ph.D., Pediatrics, $6,000; Salvatore Raiti, 
M.D., Pediatrics, $4,000; Marvin Corn- 
blath, M.D., Pediatrics, $7,600; and Ron- 
ald Gutberlet, M.D., Pediatrics, $2,000. 



microscopes for students 



In an effort to help alleviate the eco- 
nomic needs of first and second year 
medical students, the Student Council, 
Dean's Office and the Medical Alumni 
Association have contributed $2,600 to 
purchase second-hand microscopes for 
loan to these students. 

"Today there is a tremendous con- 
cern about the delivery of medical care 
to the population at large, but there is 
a tendency to overlook the needs of the 
medical student," said Peter Vash, Stu- 
dent Council president, in seeking sup- 
port for the project. "One of the more 
imminent complications of the student's 
education is cost and this problem must 
be solved before he can begin to attack 
the essentials of medical education." 

The $300 provided by the Student 
Council, the matching $300 provided by 
the .Alumni Association and the $2,000 
provided by the Dean's Office provide a 
total of $2,600 for the microscope fund 
to be administered by the Office of Stu- 
dent Affairs. Some 10 microscopes are 
now currently available for loan. Second- 
hand microscopes cost between $250- 
$300. 

Vash said that it is the hope of the 
Council to donate a similar amount each 
year so that eventually incoming stu- 
dents will not have to buy or rent their 
microscopes unless they wish to do so. 




11 




By George G. Carey, Ph.D. 

(English Department, University of Md.) 



A large segment of folk belief hinges 
on the traditional practices carried out 
in the area of folk medicine. Belief in 
the efficacy of folk healers or "pow- 
wows" as they are known in some parts 
of Maryland, has fostered an active 
trade in folk medicine over the years. 

One attempting to gather and study 
Maryland's rich bounty of folk beliefs 
will find that despite the average per- 
son's suspicion that a belief is particu- 
lar to one region, in most cases Mary- 
land superstitions are known throughout 
the country and, In certain instances, 
throughout the world. 

Conversion plays a salient part in the 
area of folk medicine. Presumably all 
folk cures suggest ways of turning sick- 
ness of some sort into health. In some 



instances, the people who propose 
these cures swear to their efficacy cit- 
ing chapter and verse of cases where 
the patient has been miraculously 
brought to health. 

"Now," reported a Crisfield, Md. man. 
"there was this girl and she was burned 
real bad, third degree burns and the 
flesh just running right off her and so 
they said you'd better go and see Miss 
Emmy. So they took her down and she 
didn't use any ointment or anything. 
Just rubbed her hands along those 
burns and when that girl healed, there 
wasn't one scar on her anywhere." 

Inevitably, women like Miss Emmy 
became accepted in the community as 
people with special powers. In some 
parts of the Eastern Shore, they became 



Editor's Note: George G. Carey, Ph.D., 36, was born in New Jersey and received his doctorate 
degree in English from Indiana University. He has written several books on Maryland folklore, 
Maryland Folklore and Folklife, published by Tidewater Publishers, Cambridge, Md. and two other 
books. Folklore of the Eastern Shore Watermen and Maryland Legends and Folksongs, will be 
published in the Fall. Portions of the text are from Dr. Carey's book, Maryland Folklore and Folklife, 
® 1970, Tidewater Publishers, Cambridge, Md. 



known as "high women," and their male 
counterparts were "high men." Their 
cures were many and varied, and 
though the white healers seem to be 
less in evidence than they were a cen- 
,tury ago, black healers still provide 
medicine for believers, both black and 
white. One such healer is found in 
Perryhawkin: 
You could probably describe Annie 
as a sweet old colored lady who 
would help anyone she could. She's 
in her late sixties and a hard worker 
— one of the best farm hands you 
can find to pick tomatoes, beans, cu- 
cumbers or anything like that. She 
lives on her social security check but 
she can't work in the factory in the 
summer because of her pension 
check. She raised seven boys and 
1 seven girls and some of them went 
to college. Everyone thinks she's one 
of the best people around. And if 
you have some minor ailment, a skin 
disease or mild sickness, you can 
just dial Annie and she'll give you a 
remedy. 

Here is a clearly defined instance of 
traditional folklife patterns fitting them- 
selves to modern conventions. Seventy- 
five years ago, one would have gone to 
the folk practitioner's house to receive 
the cure, and probably have her prepare 
and apply it. But modern communica- 
tions have changed all this. Today one 
can dial a folk remedy as simply as one 
can dial-a-prayer or the weather. 

A practical base often underlies much 
of folk medicine. Crude or unappetizing 
as some of the cures may sound, time 
and tradition have proven them effec- 
tive. When prescribed medicine is not 
easily come by because there may be 
no one to prescribe it, people fall back 
on traditional prescriptions. Many of the 
cures for colds, coughs, and croup, for 
instance, require inhaling a strong 
smelling substance. Whereas a doctor 
might prescribe a croup kettle filled 
with water and benzine. Eastern Shore- 
men wear a piece of flannel soaked in 
kerosene, and surely the smell from 
this garment would act probably more 
effectively to open up breathing pas- 
sages than a croup kettle. Likewise, 
goose grease applied to the chest, as 
is done on the Eastern Shore for a chest 



cold, would certainly help to lessen the 
chance of chill on the chest. 

The origin of much of the folk medi- 
cine practiced today on the Eastern 
Shore derives in part from the large 
pharmacopoeias published several hun- 
dred years ago. In these thick volumes 
appeared long lists of cures, then ac- 
cepted as medical fact. But with the 
advancement of scientific knowledge, 
physicians dropped many of these rem- 
edies from their practice. Still the folk 
continued to use them, and through the 
binding factor or oral tradition, many of 
the cures have persisted in time and are 
administered today as much as they 
were 200 years ago. Then, too, there is 
the simple fact that many of these folk 
remedies may have more efficacy than 
scientists are willing to admit. 




One licensed Crisfield doctor actually 
deferred to his folk counterpart for the 
treatment of warts: 
Now there used to be some 'doctors' 
in this area who could cure your 
warts. There was a time when I had 
grown a big horn wart on the end of 
my nose and I went to a regular doc- 
tor in the village and he wouldn't 
touch it. He told me to go see George 
Stevenson. Said he could fix me up. 
My regular doctor said all he used 
was spit and all he did was rub a 
little spit around on the wart and it 
went away. But in the end I didn't 
go; I went to Baltimore instead and 
had it burned off. 



13 



Some healers miraculously removed 
warts by absorbing them into their own 
skin. Others had the power to induce 
warts as well as remove them. 

If a medicinal reason can be offered 
for some traditional cures, there is little 
rationale that can be applied to the 
magic suggested in most of the cures 
provided for warts. Here's a few ideas 
to get rid of warts. 

— Take a kernel of corn and criss- 
cross it over the wart nine times. 
Then feed the corn to a chicken 
and the wart will go away. 

— Rub a wart until it bleeds; then 
rub the bleeding area with a flan- 
nel cloth, until the bleeding stops; 
then bury the cloth in the ground, 
and when it rots the wart will go 
away. 

— Tie a knot in a string over the wart 
and then throw the string into the 
water. When the string rots, the 
wart will disappear. 

— Find a hollow stump in the woods 
with water in it; wash your warts 
there and they will go away. 

— Take an old dirty penny, rub it on 
your warts, and then throw it over 
the right shoulder facing the full 
moon, and the wart will go away. 

— Rub a chicken liver over a wart; 
then put the liver in a holly tree 
in the woods and the wart will go 
away. 





Clearly, with folk medicine, the more 
common the malady, the more varied 
the traditional means of healing it. With 
a cold, for instance, one would concoct 



a brew of kerosene and sugar, or rub 
mutton tallow on the chest, or prepare a 
pine shat tea, or grease the temples 
and bottoms of feet with beef suet, or 
cover the chest with a rag soaked in 
turpentine and tallow, or simply wear 
a tar rope around the neck. 

But, if one were clever, he didn't get 
sick. He prevented colds by carrying 
an onion around in his pocket all win- 
ter, or hanging an asafetida bag around 
his neck. Other safeguards were more 
elaborate: 
To ward off colds: rub down in goose 
oil; take a fresh muskrat skin and 
sew the bloody side to a red flannel 
vest; put the red flannel next to the 
skin with the fur side out and wear 
until it falls off. 

Eastern Shoremen also use a rag 
rung out in child's urine around the 
throat. Urine also worked as a beautify- 
ing agent. Pimples disappeared if the 
face was swabbed with a wet baby's 
diaper. Fevers subsided when beaten 
horseradish was bound to the pulse 
or an onion poultice lashed to the head 
and feet. A combination of sulphur and 
molasses replaced geritol for tired 
blood in folk cures. 

Common everyday aches, pains and 
discomfort likewise found relief in folk 
remedies. An axe under the bed pre- 
vented sweating, while children were 



fed chicken gizzard to curb bedwetting. 
A wad of chewed tobacco on bee stings 
drew pain out, and placed on cuts it 
brought the wound together faster. 

A sharks tooth hung down the back 
of the neck prevented nosebleeds. If 
one occurred, however, the victim could 
either chew a piece of brown paper 
vigorously or apply a piece of brown 
paper with the word STOP written on 
it to the roof of the mouth and hold the 
Ihead back. Toothaches subsided if a 
fried egg were bound to the ear or if 
the face were bathed in water boiled 
'with a hog jowl bone. 

Children's ailments naturally de- 
manded the attention of the folk practi- 
tioner. A mole's foot dangled from the 
child's neck alleviated teething. So did 
a thimble rubbed over the gums. For 
weak infants, some bathed their heads 
*in whiskey to make them gain strength 
Ifaster. Mumps subsided when the swell- 
'ing was rubbed with the marrow of a 
hog's jawbone, or if the soot from a 
wood stove was smeared from one side 
of the face to the other. 



Less well-known afflictions also de- 
veloped traditional cures. If a person 
contracted worms, pumpkin seeds were 
the answer, or else he could wear a 
ball of garlic around the neck and say 
a prayer. The smell of garlic suffocated 
the worms. But if the patient vomited, 
it was a sign that the worms had already 
gone to the heart. 

Eastern Shore traditions also included 
a cure for love ills: 
// a woman takes a drop of blood 
from tier menses and puts it into a 
man's drinl<, he will be hooked on 
her for life, sexually. For fertility a 
man should eat sunflower seeds. 

FOLKLORE ARCHIVES 

Until recently little had been done to 
activate the study and collection of 
Maryland folklore. In 1966 the Maryland 
Folklore Archive was established at the 
University's College Park Campus. 
Since then the Archive has become the 
repository for more than seven hundred 
student and faculty collections, in ex- 
cess of ten thousand items of Maryland 
folklore. 




15 




black physicians 

Emerson C. Walden, M.D. 

The black doctor is rare and in danger 
of becoming extinct, says Dr. Emerson C. 
Walden, member of the Board of Re- 
gents, if more of them are not trained. 

Dr. Walden, who was appointed to the 
Board in January 1971, is a practicing 
Baltimore surgeon and president-elect 
of the National Medical Association. His 
sons, Emerson Jr. and Thomas, are first 
and second year medical students at 
Maryland, School of Medicine. 

The 47-year-old surgeon, who fills the 
unexpired Board of Regents term of the 
late Charles McCormick, has been in 
private practice of surgery in Baltimore 
since 1951. He is attending surgeon at 
Provident, Lutheran and South Balti- 
more General Hospitals; Surgeon Out- 
patient Department, Johns Hopkins 
Hospital and Instructor in Surgical 
Nursing, Provident Hospital. 

Dr. Walden feels there is a critical 
manpower shortage in health and this 
can be translated into the black com- 
munity: "It is estimated that a need 
exists for 50,000 physicians to serve the 
American public. If you consider that 
blacks are 12-13 per cent of the total 
population, then one could reason that 
they should be 13 per cent of the phy- 
sician population. Providing this were 
true, there would be nearly 35,000 black 
physicians in this country." 

He adds, "However, there are only 
6,000 black physicians and that makes 



them almost a 'rarity.' There needs to 
be some 30,000 additional black physi- 
cians from somewhere just to equate the 
population quota. If one considers the 
total need of 50,000 physicians then the 
majority of the need is a black need — 
50,000 minus 35,000 leaves 15,000. As a 
black physician I am commited to clos- 
ing the gap however we can do it." 

As president-elect of the NMA Dr. 
Walden explains that he and others are 
working to do something about the 
black shortage in medicine. 

"We are empathetic, as a matter of 
fact, and we have pushed the para- 
medical program, but don't see this as 
an answer completely. We don't want to 
see all impetus being put on para- 
medical people and none on black phy- 
sicians, dentists and nurses. We are not 
asking for lowering of standards. We are 
asking, especially in state supported 
schools that blacks be given an oppor- 
tunity. 

"If I am going all over the country 
telling everybody else at state schools 
what they should do where blacks are 
concerned, I certainly have to talk to 
the University of Maryland, whose rec- 
ord along with Hopkins, has been poor 
in the number of blacks and minorities 
admitted and later graduated," said Dr. 
Walden referring to his membership on 
the Board of Regents. 

The native of Cambridge, Md. also 
believes that as expounded by the late 
Whitney Young there should be a 
"Marshall Plan" with regards to blacks. 

"We need bending over backwards, 
preferential treatment, what ever you 




:all it, in this regard to get rid of educa- 
ional, economic and political barriers, 
30or housing — all the things that have 
neant that young blacks do not see 
Tiedicine as a life goal," he says. 

The National Medical Association has 
I program called "Motivation" because 
t was found that young blacks do not 
lave medicine as a life goal, but see it 
is an impossible dream. 

"I have frequently told them (blacks), 
hat I wasn't born a doctor, it was a 
strain to be trained and taught, and 
;hat opportunity is for you. I have many 
Deople who are black tell me they are 
amazed that I am a doctor. The idea 
hat you have to spend so much time in 
jchool, it costs so much money . . . 
n'ou also have to motivate parents. They 
3sk 'What do you mean going to medical 
school — I don't have that kind of 
noney — go out and make a living.' So 
/ve've had to motivate a lot of people, 
business and educators, into accepting 
:he fact that a young black can become 
a physician," Dr. Walden explains. 

The temper of the times is swinging 
:oward the direction where opportunity 
should be available to all people Dr. 
A/alden believes: 

"There is a critical problem in health 
/vhich can be ascribed to manpower 
shortages and all the way back to the 
deprivation of opportunities for all of 
Dur people. If more people get into 
nedicine, more people will be able to 
solve the medical problems. There is a 
ot of talk about National Health Insur- 
ance, health maintenance organization 
3tc., but at the crux of it is going to be 
:he guy who delivers the care. 

"In the black community, that re- 
sponsibility is going to fall back on the 
'are black physician, who numbers 
3,000, and this figure has stayed at 
3,000. If we graduate 1,000 a year, 1,000 
die or go into retirement so you never 
get ahead. 

"Therefore, if you look at the figures 
there is a reverse quota almost 99.4 per 
:ent white. There are maybe 20 black 
students at Maryland and that certainly 
doesn't come near 13 per cent. Na- 
tionally the NMA has a program called 
'Project 75' which is designed by 1975 
to have as many blacks in all medical, 
dental and nursing schools as are in the 
population, that is percentage wise. We 



on the Board of Regents, I say 'we', 
because it happened after I was ap- 
pointed, have what we call 'Project 74' 
where the same thing is suppose to 
happen here by 1974," said the newly 
appointed Regent. 

How does Dr. Walden propose the 
problem of recruiting and then graduat- 
ing more black physicians be solved 
within the state's educational system? 

"You can't wait for them (black stu- 
dents) to come to you. Recruitment must 
go into the schools. We've got to be 
more than just physicians. When black 
physicians are on admissions com- 
mittees they should see that more 
blacks get admitted; re-evaluate the 
entrance exams and requirements . . . 
We aren't asking for liquidating or 
lowering standards, but certainly broad- 
ening the base so that one reaches out 
to the black talent that is available. 

"The black talent which we (black 
physicians) are going to be telling 'Yes, 
you apply, you're qualified, you can go.' 
There's got to be a willingness that once 
a black student gets into medical school, 
he will graduate if it takes five years or 
six. You can run tutorial programs. This 
is the 'Marshall Plan' that is necessary," 
Dr. Walden remarks. "We feel the larger 
white communities had this type of 
help, this type of preferential treatment 
all along. Now it's got to be given to the 
black." 

Medical schools and larger univer- 
sities have in the past had things funded 
because of research. Dr. Walden says 
a consumer type market now exists and 
everybody is crying "where is all this 
wonderful American health we're talking 
about. It doesn't get delivered to the 
grassroots." 

He continues, "We think we have the 
people but you need more medical 
schools, you need larger classes . . . 
this means more money. You get back 
to the federal government, end the war 
and bring money back, take money from 
the space program . . . some of our 
priorities are a little out of line. The 
benefits of those programs notwith- 
standing, we think there're a whole lot 
of higher priorities at home — it takes 
money to buy brains, buy personnel and 
build buildings. You don't put up a 
medical school and it runs itself. I think 
the most important building in a city is 



17 



a hospital and the most important per- 
son probably is the physician." 

"We do not differ on the type of per- 
son needed for delivery of medical 
care," he carefully points out. "We 
want qualified people also, and what- 
ever it takes to get that, we want at the 
University of Maryland. This is what 
we'll be working for as the NMA is 
doing nationwide." 

The white physician can do more 
than he has to get rid of injustices in 
housing, jobs and education especially 
in organizations which are para-medical, 
outside the medical field, according to 
Dr. Walden. 

"When City Councils vote to cut the 
school budget, they (white physicians) 
should be writing letters, talking to 
congressmen, local, state and national, 
about seeing that proper priorities are 
established. And, these people fund 
programs and institutions designed to 
see that every American gets what is 
considered the 'American Dream' and 
that it doesn't remain a dream for 
blacks." 

Dr. Walden proposes that, "education 
as to opportunities available to blacks 
should begin perhaps upon entering 
school. There are programs in junior 
high and health clubs that support this 
orientation. We are beginning to get 
schools and types of schools where the 
abilities of the individual count more 
than the color of your skin. If he can 
produce, he moves up." 

Both of Dr. Walden's sons weie par- 
tipicants in the University's Summer Pro- 
gram for prospective medical students. 

"They are concerned that sometimes 
the people who finish it don't actually 
get into school. They would like for all 
of the people who participate in the 
summer program to move up to the next 
step of the ladder. Hopefully, some will 
come into the September class and if 
not September, some class in some 
school," he comments. 

Dr. Walden understands many of the 
problems in recruiting blacks for en- 
trance to the Maryland School of Medi- 
cine. As a graduate of Howard, he rec- 
ognizes that even two black medical 
schools must compete for applicants. 

"This is a two-edged sword because 
it raises havoc with the traditional black 
medical schools, Howard and Meharry. 




They must now compete for 'qualified' 
blacks. You must put qualified in quotes. 
Qualified by whom? The white super- 
structure or qualified in terms of their 
own life styles with the ability, if taught, 
to be physicians. You have to overlook 
certain things that have happened in 
the past as a result of the black life 
style, which has as its basis, injustice. 
"We feel that we wouldn't have any 
problem getting minority and 'qualified' 
minority students to enter medical 
schools, receive the disciplines of medi- 
cal schools and turn out to be excellent 
doctors. I hope the cure for cancer is 
not that far away . . . some black young- 
ster just might have the cure for cancer 
locked up in his brain, and, I say again, 
I hope that we're not that far off in find- 
ing a cure for cancer," he concludes. 




nutrition of cinildren in 
developing connmunities 



Barbara Underwood, M.D. 



Malnutrition among preschool chil- 
dren is a fact, not a fantasy, especially 
among the poor, illiterate and ignorant 
of developing communities throughout 
the world. 

The term "developing communities" 
rather than the more traditional termi- 
nology of "developing" countries has 
been chosen in order to encompass 
many situations which exist today in 
the United States. Until very recent 
years, the "developed" Western world 
focused concern on the poor and ignor- 
ant of Latin America, Asia and Africa, 
but showed less concern about the 
plight of people on reservations, in mi- 
grant camps, and in the Appalachias 
and Deltas, and even in the accessible 
urban ghettos of Baltimore, New York 
City and other metropolitan areas. 

The toll of malnutrition on the chil- 
dren of the world is difficult to assess 
accurately. Seldom is fatality attributed 
on death certificates to malnutrition. 
More often, gastroenteritis, measles, 
whooping cough or some respiratory or 
other infectious disease is the recorded 
killer. Usually, however, chronic under- 
nutrition so debilitates the victim that 
he is vulnerable to the ravages of an 
infection which is tolerated with mini- 
mal discomfort in a well-nourished 
individual. 

Infant mortality rates are five to ten 
times higher in countries where Protein 
Calorie Malnutrition (PCM) is frequent. 
Certainly not all of these deaths are re- 
lated to malnutrition, and one can't 
isolate malnutrition from other public- 
health and medical concerns such as 
proper sanitation, immunization, hous- 
ing and health care. 

The magnitude of the malnutrition 
aspect of the problem is dramatized by 
focusing only upon mortality in the one 
to four age group. Mortality rates in 
this age group are 20 to 50 times higher 




in many countries than those in the 
Western world. This means that less 
than y2 the children born alive can be 
expected to reach five years of age. It 
is not rare for village women in North- 
east Brazil and elsewhere to bear 13 
live babies, only to have two or three 
who survive the pre-school years. 

FAMILY PLANNING 

In developing countries family plan- 
ning programs are currently receiving 
much emphasis and financial support. 
Such programs which do not consider 
this high incidence of mortality in the 
preschool years, much of it nutrition- 
related, cannot hope to succeed. Un- 
less you can offer reasonable assurance 
that the children born will live, you can- 
not expect a poor woman to limit the 
size of her family. A Jordanian mother 
brought to a hospital a two-year-old 
child in the terminal stages of 
marasmic-kwashiorkor. She already had 
lost six children with similar symptoms. 
When asked why she continued to have 
children when she could not afford to 
feed and care for them; why didn't she 
go to the family planning clinic? She 
answered: "You can make me poor by 
not letting me have money, or land, or 
animals, but you cannot make me poor 
by not letting me have children." 



Dr. Barbara Underwood, an assistant professor at Columbia University, was the first lecturer in the 
recently created "Misbah Khan Lecture in Problems of World Health." Dr. Underwood was affiliated 
with the University of Maryland Department of Pediatrics first in 1962-64 as a research associate and 
then in 1964-68 as an assistant professor of Pediatrics. She has been at Columbia since 1968. 



19 



These deaths in the preschool years 
are preventable and reduction in this 
needless waste of human life must be of 
first priority for health workers inter- 
nationally. However, our concern must 
not be limited to reducing mortality but 
also must extend to reducing morbidity 
and the possible permanent effects of 
acute and chronic malnutrition on those 
children who survive. In these individ- 
uals lie the future hopes for raising the 
productivity and hence the economic 
level of poverty stricken populations 
around the world. Such economic de- 
velopment is fundamental to achieving 
the goal of establishing a peaceful, 
reasonably prosperous world com- 
munity. 

The evidence is quite clear that acute 
malnutrition in the first year of life, and 
perhaps during the intrauterine period, 
can have irreversible effects on organ 
development including the very impor- 
tant development of the central nervous 
system. 

The period in development in which 
growth in cell number is rapidly occur- 
ring appears to be especially vulnerable 
to an acute deficiency of calories. De- 
priving the organ of sufficient energy 
during the period when cells of an or- 
gan are being formed (hyperplasia) 
results in an irreversible decrease in 
the number of cells produced. In con- 
trast, calorie deprivation during the 
time when cells are growing in size 
rather than in number results in a de- 
crease in size of cells. Such effects are 
reversed by adequate feeding. In sum- 
mary, cells of organs may gain in weight 
by feeding more calories, but the num- 
ber of cells present cannot increase 
once the time of growth by hyperplasia 
has ceased. 

The human brain grows by hyper- 
plasia very rapidly during intrauterine 
and early postnatal life. Acute malnu- 
trition, in this period has been known 
to decrease the number of cells in the 
brain resulting in altered behavior pat- 
terns of children who survive. On the 
other hand, acute malnutrition in the 
second or subsequent years, which usu- 
ally is in the form of kwashiorkor or 
marasmic-kwashiorkor, is reversible. 
The size but not the number of brain 
cells is reduced and most studies show 
no permanent impairment in behavioral 




patterns. However, the mechanism by 
which malnutrition influences subse- 
quent behavioral patterns is not known. 
It isn't known if the number of brain 
cells directly correlates with functional 
capacity, i.e., learning ability. At pres- 
ent, it is premature to draw conclusions 
on the possible permanent effects of 
severe, early malnutrition and caution 
should be taken in interpreting the lim- 
ited data available from human studies 
and especially in extrapolations from 
data obtained from animal studies. 

Acute malnutrition manifested as 
marasmus or kwashiorkor affect rela- 
tively small numbers of children com- 
pared with the masses of children who 
are simply chronically undernourished. 
These children simply fail to grow at an 
expected rate. However, the possible 
effects, especially in the preschool 
years, of chronic undernutrition in 
childhood on the physical and mental 
capacity of adult populations are not 
known. 

Failure to grow at a normal rate after 
the first four to six months of life typi- 
fies the child populations of poverty- 
stricken communities. Nearly all new- 
borns in these communities abroad are 
breast fed and for about four months 
their growth equals or exceeds that of 
children of prosperous communities. 
Subsequent growth usually falls below 
the accepted standard until about the 
fourth or fifth year when growth may 
again parallel the standard but at a 
lower level. The critical period of in- 
adequate growth manifested at about 



six months corresponds to the time 
when breast milk becomes quantita- 
tively inadequate to meet calorie needs. 
This is realized by most mothers who, 
according to cultural dictates, introduce 
supplementary feeding at about six to 
nine months. Usually the supplementary 
food consists of small portions of the 
family diet, which may be a spicy curry, 
or of a watery gruel which add little 
quantitatively or qualitatively toward 
meeting the child's real food needs. In 
fact, because such food is often pre- 
pared and fed under poor sanitary con- 
ditions, it may be a significant source 
of contaminants leading to diarrheal 
disease. 

The growth stunting of early child- 
hood may never be fully recovered. A 
child from a poor family may be re- 
tarded by 2 to 4 years in growth achieve- 
ment and never fully attain his apparent 
genetic potential. 

Is it really so important for people 
to achieve their full growth potential? 
The answer is no when considering 
stature only. There are advantages to 
populations of "little people" — less 
space required, less protoplasmic mass 
to support, smaller cars, less material 
for clothing, etc. But, data suggest that 
the significant growth retardation after 
the first year among the poor reflects 




the chronic debilitating effects of sub- 
adequate nutrition which in turn is 
manifested in an increased morbidity. 
Most certainly increased morbidity 
means decreased productivity. 

Malnutrition develops because of 
improper food given under unsanitary 
conditions. Poverty is part, but not all, 
of the problem. Ignorance as to the 
food needs of the child and how to sup- 
ply these in a wholesome manner within 
the cultural context and the economic 
potential of the family is the major 
cause of preventable malnutrition. 

Theoretically, the solution to this 
problem is known and the technical 
competence to alleviate malnutrition is 
available but those concerned have 
failed to find practical ways of getting 
the message to mothers. Why? Some 
solutions which have been tried but 
largely failed include: 

— Food distribution programs of dry 
skim milk, corn-soya mixture, etc. 
or food stamp programs. These 
meet acute needs but are not long- 
term solutions; they do not change 
feeding practices and their effect 
terminates when the supply is ex- 
hausted. Further, they bear the 
stigma of charity. 

— Lecture courses for mothers by 
professionals in traditional die- 
tetics. Often these courses bear 
little relation to the reality of the 
poverty-plagued environment of 
the mother. 

An effective program has emerged 
during the 1960's and has now proven 
its practicality and long range effective- 
ness in over 17 different countries. The 
program known as Mothercraft Centers 
or Nutritional Rehabilitation Centers 
recognizes certain basic facts about the 
environment which breeds malnutrition. 

1. Extreme poverty. 

2. Illiteracy or ignorance as to the 
food needs of children. 

3. Limited numbers of trained pro- 
fessionals available in relation to 
the vast need. 

4. Suspicion and distrust of the highly 
educated professional by the illiter- 
ate and ignorant. 

Recognizing these facts, programs are 
developed which, as stated by K. King, 
attempt to educate mothers "in the best 
practical, hygienic feeding practices 



21 



for their children that are compatible 
with their financial, educational and 
food resources." Traditional dietetics, 
the meat, milk, egg approach, is useless 
in this setting. Familiarity with the cul- 
tural and child rearing practices is es- 
sential in order that nothing is taught 
that the mother cannot immediately put 
into practice in her home. Menus must 
not only be low-cost and nutritious but 
must be tailored to the food practices 
of the particular culture. The profes- 
sional cannot ram-rod the basic seven 
or the basic four concepts of nutrition 
down the throats of a distrusting group 
of mothers. 

Mothercraft Centers making use of 
locally available foods and personnel 
have successfully eradicated malnutri- 
tion as a significant contributor to pre- 
school mortality in several communi- 
ties. The secret of success is to retain 
a low-cost program and to bridge the 
gap of apprehension by using com- 
munity leaders of limited education; 
leaders with whom the mothers can 
identify and in whom they trust. 

There are some dangers in develop- 
ing Mothercraft programs. One tend- 
ency is to develop these programs into 
sophisticated health centers. The pro- 
gram must develop on the local level 
at a rate compatible with the com- 
munity's ability to support its needs. 
The more the program is identified with 
the community, the greater its chances 
for permanent acceptance. 

The underlying philosophy of pre- 
venting malnutrition abroad applies 
equally well to the "developing com- 
munities" in the U.S. Commodity 
food programs, school lunch programs 
and food stamp programs alone are not 
long term solutions. Community action 
must institute programs utilizing low 
level "teachers" to get the message to 
the mother. The Headstart concept has 
much merit, but largely ignores the 
mother's education and is a bit late in 
preventing malnutrition in the critical 
first years of life. The gap of apprehen- 
sion and suspicion which has devel- 
oped among the minority and ghetto 
populations can't be completely judged 
by health professionals. Local, perhaps 
less educated, but wholly dedicated 
talent must be tapped to reach these 
people. 



Recently, the Young Lords of New 
York City used unacceptable means to 
take over a Church and establish a 
breakfast center for preschool children. 
Irrespective of their method, they estab- 
lished a needed service which was 
accepted and welcomed by the com- 
munity. Is there not some way this dedi- 
cation to improving the lot of the poor 
can be tapped and channeled into effec- 
tive long range programs? It is the 
responsibility of health professionals 
to shake off the shackles of traditional 
approaches to education and be recep- 
tive to creative and what may some- 
times appear radically new approaches. 
The main ingredient needed is com- 
passion and a dedication to serve 
needy people. 



REFERENCES 

LNaeye, R. L., M. M. Diener, H. T. 
Harcke, Jr. and W. A. Blanc. Relation 
of poverty and race to birth weight 
and organ and cell structure in the 
newborn. Pediat. Res. 5: 17, 1971. 

2. Winick, M. Nutrition and Mental De- 
velopment. Med. Clin. N. Amer. 54: 
1413, 1970. 

3. Winick, M. Fetal Malnutrition. Clin. 
Obstetrics and Gynecology 13: 526, 
1970. 

4. Underwood, B. A. et al. Height, 
weight and skin-fold thickness data 
collected during a survey of rural and 
urban populations of West Pakistan. 
Am. J. Clin. Nutr. 20: 694, 1967. 

5. Gordon, J. E. Diarrheal disease of 
early childhood — worldwide scope 
of the problem. Ann. N.Y. Acad. Sci. 
176: 9, 1971. 

6. A Practical Guide to Combating Mal- 
nutrition in the Preschool Child. 
Appleton-Century-Crofts, N.Y., 1970. 

7. King, K. W. Mothercraft Centers. 
Nutr. Rev. 28: 307, 1970. 



dean's thoughts 



People have often asked me what the 
Tiost glaring defect in our health care 
system is. In my opinion it is its orga- 
lization and delivery system. Often 
leaith manpower in terms of sheer 
lumbers is pointed out to be the most 
::)ressing problem. It is true, we don't 
lave enough physicians. There's no 
:iuestion that we need more doctors 
and all types of allied health personnel. 
However, if one looks at the numbers 
ust as numbers, one finds that the edu- 
:ational system has been producing 
Tiore physicians each year; indeed the 
'ise in the number of physicians has 
actually outstripped proportionately the 
rise in population. This is even more 
true of nursing and some of the other 
allied health professions. The number 
Df people trained in these disciplines 
juring the past ten years is astronomical. 

A major contributor to the problem is 
:hat the health care delivery system 
Deing used today is essentially decen- 
:ralized with "individual" physicians 
and "individual" offices. One way to 
:ombat this would be to produce enough 
'individual" physicians so that they 
:ould be distributed equitably. Unfor- 
tunately this requires a vast number, 
a number perhaps than our society is 
/villing to pay to produce. The theory 
Dehind this approach is that if the de- 
sirable areas of practice become satu- 
rated more physicians will begin to 
Tiove into the rural and central city 
areas. 



Some people advocate using new 
types of group specialists in new ways; 
others advocate a new type of practi- 
tioner, or "specialist," called a family 
practitioner. Still others advocate using 
more allied health professionals, some 
using less. 

No one knows the answer at this point 
in time but one of the values of the 
university academic medical center 
might be to try some of the various 
experiments and see which one comes 
out best. The goal to be achieved is a 
situation in which the health profes- 
sional and the consumer (patient) both 
get a reasonable amount of happiness 
out of the relationship. 
(This is excerpted from an interview 
with Dean Moxley which appeared in 
The Paper.) 



23 



m^-'ml'' 







1971-72 internships 



Alexander, Arnold 
Allan, Thomas 
Aquilla, Joseph 
Balcer, Richard 
Barnett, Leslie 
Barney, Robert 
Beall, Peter 
Benson, Brian 
Blumberg, Lawrence 
Bollino, Anthony 

Bondi, Elliott 
Bordow, Richard 
Bouchelle, William 
Bozzuto, James 
Brennan, Thomas 
Brenner, Elizabeth 



Maryland General Hosp. 
Baltimore, Md. 

Hartford Hosp. 
Hartford, Conn. 

Mercy Hosp., Inc. 
Baltimore, Md. 

Maryland General Hosp. 
Baltimore, Md. 

University of Md. Hosp. 
Baltimore, Md. 

Greater Balto. Med. Center 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Virginia 
Charlottesville, Va. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Conemaugh Valley Mem. 

Hosp. 
Johnstown, Pa. 

Maimonides Hosp. 
Brooklyn, N.Y. 

Mt. Sinai Hosp. 
New York, N.Y. 

Univ. of Md. Hosp. 
Baltimore, Md. 

U.S. Public Health Serv. 
San Francisco, Calif. 

Mercy Hosp., Inc. 
Baltimore, Md. 

Chicago Wesley Mem. Hosp. 
Chicago, III. 



Rot./ Med Major 
Straight Medicine 
Straight Medicine 
Rot./Med Major 
Straight Medicine 
Straight Medicine 
Straight Surgery 
Rot./Peds Major 
Straight Surgery 
Family Prac. Res. 

Straight Medicine 
Straight Medicine 
Straight Medicine 
Rot./Surgery Major 
Straight Medicine 
Str. OB-GYN 



Jrenner, Robert 
prouillet, George 
Juckler, Leroy 
5yank, Ronald 
^ahen, Lucienne 

Callahan, Arthur 
Damp, Michael 
Ghaney, Charles 
Clayton, JoAnn 
iChang, Margan 
iCohen, Daniel 
Cohen, Harold 
iCohen, Susan 
iCorman, Larry 
Detrich, Terry 

!J 

iDobson, Margaret 

it 
Dubin, Alan 

Edelstein, Michael 

Eden, Kenneth 

Faulkner, Michael 

I Feig, Steven 

Flax, Fredric 



Sinai Hosp., Inc. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

St. Agnes Hosp. 
Baltimore, Md. 

Sinai Hosp., Inc. 
Baltimore, Md. 

Massachusetts General 

Hosp. 
Boston, Mass. 

Lenox Hill Hosp. 
New York, N.Y. 

Geisinger Medical Center 
Danville, Pa. 

St. Agnes Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Boston Univ. Hosp. 
Boston, Mass. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Sinai Hosp., Inc. 
Baltimore, Md. 

Children's Hosp. 
Los Angeles, Calif. 

Mercy Hosp., Inc. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Mercy Hosp., Inc. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Maryland General Hosp. 
Baltimore, Md. 

Children's Hosp. 
Los Angeles, Calif. 

Grady Memorial Hosp. 
Atlanta, Georgia 



Rot./Med Major 
Straight Surgery 
Rotating 

Rotating 

Straight Pediatrics 

Rot./Surg. Major 

Rotating 

Rotating 

Straight Pediatrics 

Straight Pediatrics 

Straight Pediatrics 

Psychiatry Residency 

Rotating 

Straight Pediatrics 

Straight Medicine 

Straight Pathology 

Psychiatry Residency 

Rotating 

Rotating 

Rot./OB-GYN Major 

Straight Pediatrics 

Straight Pediatrics 



25 



Fleming, Lawrence 
Foody, William 
Foster, Michel 
Fradkin, Maury 
Frankel, Joshua 
Frey, Jeffrey 
Gelrud, Louis 
Genut, Abraham 
Glass, Burton 
Gordon, Edward 
Greenspan, Robert 
Greifinger, Robert 
Grosart, Gary 
Haggerty, John 
Harper, William 
Hartmann, Peter 
Herbst, Jerry 
Higgins, Ivanhoe 
Ho, Ben 

Hobelmann, Charles, Jr. 
Hofwits, Gwynne 
Huber, Stanford 
Jarrell, T., Ill 



Univ. of Md. Hosp. 
Baltimore, Md. 

Army Medical Serv. Hosps. 
Washington, D.C. 

Medical Coll. of Virginia 
Richmond, Va. 

Grady Memorial Hosp. 
Atlanta, Georgia 

Sinai Hosp., Inc. 
Baltimore, Md. 

Washington Hosp. Center 
Washington, D.C. 

Medical Coll. of Va. 
Richmond, Va. 

U.S. Public Health Serv. 
Baltimore, Md. 

Meadowbrook Hosp. 
East Meadow, N.Y. 

Martland Hosp. 
Newark, N.J. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Montefiore Hosp. 
Bronx, N.Y. 

Hartford Hosp. 
Hartford, Conn. 

U.S. Public Health Serv. 
San Francisco, Calif. 

Washington Hosp. Center 
Washington, D.C. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Mt. Zion Hosp. 

San Francisco, Calif. 

Naval Hospitals 
Oakland, Calif. 

Naval Hospitals 
San Diego, Calif. 

South Balto. General Hosp. 
Baltimore, Md. 

South Balto. General Hosp. 
Baltimore, Md. 

Grady Memorial Hosp. 
Atlanta, Georgia 



Straight Medicine 
Straight Surgery 
Rot. /Med Major 
Rot./OB-GYN Major 
Rot./Med Major 
Rotating 

Straight Medicine 
Straight Medicine 
Straight Pediatrics 
Straight Pediatrics 
Straight Medicine 
Social Medicine 
Straight Medicine 
Rot./Surg. Major 
Rotating 

Family Pract. Res. 
Straight Surgery 
Rotating 
Rotating 
Rot./Med Major 
Straight Medicine 
Rotating 
Straight Medicine 



Kahan, Sherman 
Kay, Jerald 
Kay, Rena 
Keown, Richard 
Kiang, Henry 
Klimt, Claudius 
Kowalczyk, Wallace 
Kramer, John 
Krames, Elliot 
Krasner, Robert 

Lampton, Edward 
Lehman, Robert 

Linthicum, William 
Lissauer, Jack 
Magid, Warren 
Maloney, Michael 
Mattern, Michael 
McCann, David 
Mentzer, Robert 
Mitchell, Jeffery 
Monsour, Roy 
Moulsdale, James 



Maryland General Hosp. 
Baltimore, Md. 

Cincinnati General Hosp. 
Cincinnati, Ohio 

Cincinnati General Hosp. 
Cincinnati, Ohio 

Maryland General Hosp. 
Baltimore, Md. 

Memorial Hosp. 
Long Beach, Calif. 

Mercy Hosp., Inc. 
Baltimore, Md. 

Univ. of Miami Affil. 
Miami, Florida 

Washington Hosp. Center 
Washington, D.C. 

Mt. Zion Hosp. 

San Francisco, Calif. 

Nev^ England Medical 

Center 
Boston, Mass. 

Children's Hosp. 
Pittsburgh, Pa. 

Sheppard & Enoch Pratt 

Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Chicago Clinics 
Chicago, III. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Mary Imogene Bassett Hosp. 
Cooperstown, N.Y. 

Univ. of Minnesota 
Minneapolis, Minn. 

Duke Univ. Med. Center 
Durham, North Carolina 

Univ. of Virginia 
Charlottesville, Va. 

Univ. of Md. Hosp. 
Baltimore, Md. 

York Hosp. 
York, Pa. 

Univ. of Md. Hosp. 
Baltimore, Md. 



Straight Medicine 
Psychiatry Residency 
Psychiatry Residency 
Rot./Med Major 
Rotating 
Rotating 

Rot./Anesth. Major 
Straight Medicine 
Straight OB-GYN 
Straight Surgery 

Straight Pediatrics 
Psychiatry Residency 

Family Pract. Res. 
Straight Medicine 
Rot./Anesth. Major 
Straight Medicine 
Straight Surgery 
Psychiatry Residency 
Straight Surgery 
Psychiatry Residency 
Rotating 
Straight Surgery 



27 



Neborsky, Robert 
Ostroff, Robert 
Richards, Rufus 
Riffelmacher, Gerald 
Rocklin, Donald 

Rogers, Paul 
Ruebush, Trenton 
Sacks, Henry 
Samuels, William 
Sanders, Michael 
Schaffer, Gerald 
Schultz, Michael 
Schreter, Robert 
Schuman, Robert 
Schwartz, Susan 
Seligmann, Ralph 
Shannon, Robert 
Sharrock, Robert 
Shevitz, Stewart 
Shiian, Joel 
Silverman, Thomas 
Sitaras, P. L. 



Grady Memorial Hosp. 
Atlanta, Georgia 

Highland-Martinez-V.A. 
Martinez, Calif. 

Highland General Hosp. 
Oakland, Calif. 

St. Elizabeth's Hosp. 
Brighton, Mass. 

New England Medical 

Center 
Boston, Mass. 

Unif. of Calif. Hosp. 
Los Angeles, Calif. 

Univ. of Penn. Hosp. 
Philadelphia, Pa. 

Maryland General Hosp. 
Baltimore, Md. 

Mary Imogene Bassett 
Cooperstown, N.Y. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Albany Hosp, 
Albany, N.Y. 

Sinai Hosp., Inc. 
Baltimore, Md. 

Beth Israel Hosp. 
Boston, Mass. 

Kaiser Foundation Hosp. 
San Francisco, Calif. 

Washington Hospital Ctr. 
Washington, D.C. 

Washington Hosp. Center 
Washington, D.C. 

Montefiore Hosp. 
Bronx, N.Y. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Good Samaritan Hosp. 
Portland, Oregon 

Greater Balto. Med. Ctr. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

University Hosp. 
Cleveland, Ohio 



Straight Medicine 
Straight Medicine 
Rotating 

Straight Medicine 
Straight Medicine 

Straight Pediatrics 
Straight Medicine 
Rot./Medicine Major 
Rot./Psych. Major 
OB-GYN Residency 
Straight Medicine 
Straight Surgery 
Psychiatry Residency 
Rotating 

Rot./Medicine Major 
Straight Medicine 
Social Medicine 
Family Pract. Res. 
Rotating 
Rotating 

Rot./Psych. Major 
Straight Surgery 



Smith, James 
Smyth, Dennis 
Steele, Anthony 
Steele, Marshall 
j Stone, John 

Stuart, William 
Termini, Benedict 
Thompson, Kerry 
i Tiffany, Harriet 
! Tomie, Sachiko 

I 

Tompakov, Harvey 
Tompakov, Janee 
i Trippe, Bruce 
Weinfeld, Robert 

Weiss, Kenneth 

Whitehead, Robert 
Whitman, Walt 
Wilson, Nancy 

Wirsing, Charles 

Woolsey, Carl 



United Christian Hosp. 
Lehore, West Pakistan 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Virginia 
Charlottesville, Va. 

Conemaugh Valley Mem. 

Hosp. 
Johnstown, Pa. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Mercy Hosp., Inc. 
Baltimore, Md. 

Army Med. Serv. Hosps. 
Washington, D.C. 

Albert Einstein 
Philadelphia, Pa. 

L.A. County USC Med. Ctr. 
Los Angeles, Calif. 

Mt. Sinai Hosp. 
Miami Beach, Fla. 

Mt. Sinai Hosp. 
Miami Beach, Fla. 

Washington Hosp. Center 
Washington, D.C. 

George Washington Univ. 

Hosp. 
Washington, D.C. 

Greater Balto. Med. Ctr. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 

Tucson Med. Educa. 

Program 
Tucson, Arizona 

Seton Psychiatric Institute 
and St. Agnes Hosp. 
Baltimore, Md. 

Univ. of Md. Hosp. 
Baltimore, Md. 



Straight Pathology 
Straight Medicine 
Straight Pediatrics 
Family Pract. Res. 

Straight Medicine 
Straight Medicine 
Straight Surgery 
Straight Pediatrics 
Straight Pediatrics 
Rot/Medicine Major 
Rot./Medicine Major 
Straight Medicine 
Straight Medicine 

OB-GYN Residency 

Straight Medicine 
Straight Medicine 
Rotating 



Combined Internship 
and Residency Program 

OB-GYN Residency 



29 





ambulatory health services -a new era 



William S. Spicer Jr., M.D. 



There can be little doubt in any health 
professional's mind that we are in a 
period of significant change in the de- 
livery of health care. While few of us 
expect or desire a total upheaval, we do 
anticipate that there will be some 
changes in the nature and practice of 
medicine, in the methods of payment 
for health care delivery, in the utiliza- 
tion of other health professionals, and 
in the organization of health profes- 
sionals for decision-making and quality 
of care controls, e.g., peer review. This 
is a time, therefore, in which decisions 
will be made which will have an impact 
on the way physicians presently in prac- 
tice are able to carry on their practice 




and in which physicians yet to come 
will be trained. However, this period of 
change will not only affect physicians, 
but all other types of health profes- 
sionals as well, possibly even including 
types not presently available. 

Our experience with the so-called 
"research revolution," which began ap- 
proximately 20 years ago, has been the 
discovery that changes which occur in 
the medical school will have a profound 
effect on the future practice of medi- 
cine. From our past experience, we can 
recognize that the change from the 
training of generalists to the training 
of highly-specialized and sub-special- 
ized individuals has been a predominent 



Editor's Note: Dr. Spicer, associate dean, was named to head the Health Care Programs division 
when it was created by Dean John H. Moxley III in October 1969. He received his M.D. degree from 
the University of Kansas, School of Medicine. 



feature of the past 20 years of 
health care delivery. It Is, therefore, 
reasonable to assume that if the medical 
school once again makes a rather 
marked change in its mode of educating 
medical students, the impact of this 
change will be felt for the next two 
decades. For that reason, it is exceed- 
ingly important that any changes which 
occur in the University of Maryland, 
School of Medicine, and in the other 
health professional school curriculum 
and programs be carefully thought out, 
and that every opportunity be made 
available for thorough consultation and 
coordination with all of the health pro- 
fessional members who are concerned. 
Now is the time and the opportunity to 
bridge some of the gaps between faculty 
and alumni, to recognize that there is 
little or no room for carping, but a great 
need for consultation and constructive 
criticism through the establishment of 
new lines of communication. 

The Medical School is proceeding to 
make changes in its own mode of de- 
livery of health care, in the education 
of its students, and in its relationship 
with its surrounding community of both 
lay people and health professionals. It 
is proceeding on the following postu- 
lants: 

1. All health professional education 
must be founded on the demonstration 
of the delivery of optimal health care; 

2. We must start from a working defi- 
nition of optimal health care for the 
future. Our present working or opera- 
tional definition of optimal health care 
is: Optimal health care for large num- 
bers of people is provided by health 
care teams and includes these ele- 
ments: 

a) Detection of symptomatic and 
asymptomatic disease and identi- 
fication and introduction of indi- 
viduals who make up a "popula- 
tion" into the health care system. 

b) Health maintenance and disease 
prevention, including collecting 
and maintaining a lifetime history 
of health and disease. 

c) Education of the consumer for 
health maintenance, disease pre- 
vention, utilization of available 
services and disease therapy. 

d) Diagnosis and management of 
disease. 



e) Coordination of community re- 
sources to support individuals and 
families. 

f) A health care information system 
which assures referral, scheduling, 
consultation and retrieval of indi- 
vidual patient records and data. 

g) Quality of care control and system 
evaluation. 

At the present time, our health care 
delivery and educational programs em- 
phasize the diagnosis and management 
of symptomatic disease. They are 
mostly concerned with the sick and very 
sick individuals, usually those in hos- 
pital beds. Instead, we must develop 
concern for all elements of care. Opti- 
mal and economically realistic health 
care is best delivered to a defined pop- 
ulation in a coordinated, hierarchical 
system of primary, secondary and ter- 
tiary care, with built-in regulation of 
flow into and through the different parts 
of the system. 

For our present purposes, we accept 
these definitions of primary, secondary 
and tertiary care: 




Primary care is the care which the 
patient receives when he first ap- 
proaches the health services system 
and during continued participation, 
active or nonactive, in the process of 
medical care. Primary care includes 
the elements of comprehensiveness, 
continuity, prevention, etc. suggested 
above. It also includes acute episodic 
and emergency care. It is "caring for" 
and "caring about" the patient; and 
it is the coordinator and advocate of 
the patient's movement within the 
care system. Primary care does not 



31 



always have to be provided by physi- 
cians, but it should be supervised 
and monitored by them. 
Secondary care is specialty consul- 
tation. Referral to secondary care 
should come from primary care pro- 
fessionals. It should normally be on 
an ambulatory basis. The patient 
should return to primary care upon 
the completion of secondary care, or, 
in selected instances, continue to re- 
ceive secondary care and manage- 
ment for a particular problem in con- 
junction with overall primary care. 
Tertiary care is bed care in an insti- 
tution. It is the most misused element 
of our present health care system. It 
not only increases the cost of the 
whole health services system, but 
may be harmful and even life-threat- 
ening. Its purposes and constraints 
must be re-defined. 
3. It is very important that we recog- 
nize that our working definition implies 
an increase in the quantity, as well as 
the quality of care. 

The vast majority of health care de- 
livery is involved with the ambulatory 
patient. The intense and growing con- 
centration of the health professional 
schools with educational and training 
programs surrounding the bed patient, 
and particularly the bed patient in 
highly specialized University Hospital, 
has provided all of the students with a 
limited view of the practice of medicine. 
It would seem apparent that the place 
in which change would first occur in the 
health educational curricula would there- 
fore be in a marked expansion and re- 
definition of the ambulatory care serv- 
ices. 




At the beginning, it is pertinent to 
say that we do not believe there is only 
one way to deliver optimal health care 
and, in fact, we feel strongly that in this 
country there should be a multiplicity 
of ways. We also feel that our students 
should be exposed to as many options 
as possible in order for them to make 
a reasonable and logical career choice. 
For the University Health Science Cen- 
ter and its own campus, these options 
will be fairly limited. However, through 
a broad affiliation program with com- 
munity hospitals, group practices, fam- 
ily practitioners and voluntary agencies, 
it should be possible to provide a co- 
ordinated and regional health care edu- 
cation program. 

In our definition of optimal health 
care, we state that delivery of care will 
probably be a team effort. There must 
be, however, many types of health care 
teams. The team concept involves the 
coordinated sharing of responsibility by 
members of the various health profes- 
sions in order to improve the efficiency 
and effectiveness of utilization of health 
resources, costs and services, and in 
order to increase the comprehensive- 
ness of health services. 

The health care team is not a new 
concept, per se. The practicing physi- 
cian and his nurse or secretary are 
traditional examples of teamwork de- 
signed to increase the capacity of the 
physician and the quality of care. How- 
ever, it is important to note that the 
University of Maryland has an obliga- 
tion to train all types of health profes- 
sionals because of its location in the 
heart of the inner-city, thereby develop- 
ing teams which can best serve its role 
in education and training. These teams 
are likely to be large and complex for 
two reasons: They must provide a basis 
for training a broad variety of both un- 
dergraduate and postgraduate health 
personnel, e.g., physicians, nurses, 
pharmacists, etc.; and, our location in 
the heart of the urban complex provides 
a population whose health care needs 
are large; and the fulfillment of these 
needs is critical to the renewal of the 
inner-city. 

Under the auspices of the Office of 
Health Care Programs, a number of 
changes are already under way with the 
goal of delivering optimal health care. 



Primary emphasis is being placed on 
Ambulatory Services and, in particular, 
on the development of primary care. In 
terms of education, our training pro- 
grams are now concerned with the ex- 
pansion of the role of the nurse and the 
pharmacist. In our plans for the devel- 
opment of primary care, we are stress- 
ing two types, i.e., the development of 
a family medicine program and the de- 
velopment of a general internist-general 
pediatrician-general obstetrician com- 
bination primary care unit. 

In order to improve the quantity as 
well as the quality of health care, our 
present activities in ambulatory nursing 
services serve as an immediate exam- 
ple of change. The role of the nurse is 
being expanded with the development 
of nurse clinics, nurse practitioner pro- 
grams and our fundamental core pro- 
gram, which is called the Primary Care 
Nurse Program. In this program, the 
nurse's role is being altered from one 
which is primarily task-oriented to one 
which is whole-patient-oriented in close 
working cooperation and consultation 
with the physician. In reviewing the 
seven elements of optimal health care 
described earlier, it appears to us that 
the primary care nurse should be pre- 
pared to make a contribution, to a 
greater or lesser extent, to all of the 
seven elements. Thus, a further purpose 
of this program is to enlarge the role 
of the nurse. 





Upon completion of the North Hos- 
pital Building in 1972, our ambulatory 
care space will have been expanded 
threefold. We hope that by the time we 
move into this new building, most of our 
new basic training and educational pro- 
grams will have been completed. In- 
cluded in these programs are those 
directly related to patient care, such as 
new training programs and new staffing 
patterns in the Emergency Department 
and the Out-Patient Department, and 
others such as changes in the health 
care record system, patient scheduling 
and flow and administrative support. 

During this period of change, com- 
munication plays a vital role in linking 
together all the people who are directly 
and indirectly concerned. The Ambula- 
tory Health Services publishes a News- 
letter which attempts to bring to all 
personnel the descriptions of changes 
now in progress and the opportunities 
for their involvement in these changes. 
Any alumni interested in following this 
program are invited to receive this 
newsletter. To be included in our mail- 
ing, please contact Mrs. Susan Dilts, 
Office of Health Care Programs, Room 
551, Howard Hall, 660 West Redwood 
Street, Baltimore, Md., 21201; or call 
955-7195. 



33 



professors of surgery 1807-1970 

(a two-part series) 



Harry C. Hull, M.D. 




John davidge 



John Beale Davidge (tenure 1807-12) 
was born at Annapolis, Md. in 1768. His 
father was an ex-captain in the British 
Army and his mother, Honor Howard, 
was a relative of Col. John Eager 
Howard. 

Despite the early loss of his father, 
and having little or no funds, he re- 
solved to obtain an education. Davidge 
inherited some slaves after the death 
of a relative, and with further aid from 
friends, he was able to enter St. John's 
College at Annapolis. He obtained his 
master's from St. John's in 1789 and 
after a preceptorship under Dr. Murray 
of Annapolis, he entered the University 
of Edinburgh. It is recorded, however, 
that for financial reasons, he obtained 
his M.D. at Glasgow University, April 
22, 1793 at age 25. 

In the same year, he married a Scot, 
Wilhelmina Stuart, and moved to Bir- 
mingham, England where he practiced 
until 1796. He then returned to Baltimore 
and settled permanently. 



In 1797 an epidemic of yellow fever 
struck Baltimore and his views on the 
epidemic, published in a volume in 
1798, attracted considerable notice. The 
doctor remained in the "limelight" 
thereafter. As early as 1802 he adver- 
tised private courses of lectures to 
medical students, which continued an- 
nually until they merged with lectures 
at the opening of the College of Medi- 
cine of Maryland in 1807. 

His positive views kept the College 
of Medicine of Maryland in the fore- 
ground of American Medicine. He dis- 
agreed with the, then greatest figure in 
American medicine, Dr. Benjamin Rush. 
Rush's theory held that all diseases 
were identical and that one "universal 
cure" was appropriate for all. Davidge 
convinced his colleagues, however, that 
each disease was different and had to 
be studied and treated differently. The 
rivalry continued to the point of per- 
sonal animosity between Rush and 
Davidge. "The Maryland Theory" of 
Davidge was recognized in prevailing 
medical circles throughout the country. 

As at the few schools of medicine in 
the United States at that time, Davidge, 
as did others, wore several hats. At 
times he was listed as Professor of 
Surgery, Professor of Anatomy and of 
Mid-Wifery. Therefore, his writings were 
as expected, diverse, and were more 
on medical than surgical subjects. 

Among his writings were: "Dissertatio 
Physiologia de Causis Catamensorum," 
Birmingham, 1794; "Treatise on Yellow 
Fever," Baltimore, 1798; "Nosologia 



Editor's Note: Dr. Harry C. Hull, M.D., professor clinical surgery, delivered this paper "The 
Professors of Surgery, The University of Maryland, School of Medicine 1807-1970," at the l^edical 
Staff Meeting, March 18, 1971. Because of its historical interest and length, the paper will appear 
in a two-part series in this and a future issue of the Bulletin. Nine men have headed the Department 
of Surgery since 1807 and five of them are discussed in the first installment. 



\/lethodica," Baltimore, 1812 and 1813; 
'Physical Sketches," two volumes, Bal- 
timore, 1814 and 1816, and "Treatise 
Ipn Amputation," Baltimore, 1818. 
I Many of his theoretical views were 
Interesting: that phthisis pulmonalis was 
scrofula of the lungs; that hemorrhage 
^as arrested by retraction of vessels 
and not contraction; that menstruation 
was a secretion of the uterus excited 
by ovarian irritation; that the speculum 
uteri should not be used, because it 
"smacked of immoral curiosity"; that 
yellow fever should not be treated by 
bleeding; that yellow fever was non- 
contagious but propagated by the at- 
mosphere; and that black vomit was a 
morbid secretion derived chiefly from 
the liver. 

Davidge was considered a much bet- 
ter speaker than writer. He was revered 
by his students and usually received 
special applause at the Commence- 
ments where he was acclaimed by all 
as the "Father of the University." 

Described as a short stout man of 
florid complexion, homely features, 
small hands and feet and graceful car- 
riage, his manners were grave, formal 
and dignified and his dress very neat. 
His influence throughout Maryland was 
considerable and he was popular with 
his colleagues. 

As a surgical technician, he was slow 
and cautious. The most important oper- 
ations he performed were: amputation 
at the shoulder joint, 1793; successful 
ligation of the gluteal artery for an 
aneurysm; ligation of the carotid artery 
for "fungus of the antrum" and extirpa- 
tion of the parotid gland, 1823. 

The doctor was still active in the 
medical school, teaching Anatomy at 
the age of 61. In January 1829 he de- 
veloped a carcinoma of the antrum. The 
lesion progressed rapidly and was ac- 
companied by excruiating pain, which 
was treated by hugh doses of laudanum 
He died at his home on Lexington St. 
August 23, 1829. 

; It is cogent to note that Cordell in 
Volume I, University of Maryland, 1907, 
stated: "it is a regrettable fact that his 
relations and services to the University 
have not suggested to his successors, 
some memorial in his honor in the in- 
stitution which owes its existence and 
a large part of its success to him." 




William gibson 



William Gibson (tenure 1812-19) was 
born in Baltimore, March 14, 1788. 
Called by some the "academic vaga- 
bond," he was educated at St. John's 
and Princeton Colleges. He attended 
the University of Pennsylvania Medical 
School for a short time. He was not 
impressed with that medical school and 
was cocky enough to tell his fellow 
students that one day he would succeed 
Professor Physick in the Chair of Sur- 
gery at Pennsylvania. Later his boasting 
came true. 

At the age of 18, Gibson went to 
Scotland and entered the University 
of Edinburgh, from which he received 
the M.D. degree in 1809 at the age of 
21. His inaugural thesis about racial 
differences in the human skeleton 
brought him much credit. This work was 
done in the Munro Museum. After grad- 
uation he went to London and became 
a pupil of Sir Charles Bell. In 1810 he 
returned to Baltimore and at once be- 
came active in the profession. In 1812, 
at the early age of 24, he was made 
Professor of Surgery at the College of 
Medicine of Maryland. 

During the summer of 1812, political 
riots occurred in Baltimore. One man 
who sustained a gunshot wound of the 
abdomen, was referred to Dr. Gibson, 
who litigated the right common iliac 
artery close to the aorta, and sutured 
several holes in the intestine. Although 
the patient died fifteen days later "from 
ulceration of the artery and peritoneal 
inflammation," this daring operation 



35 



established Dr. Gibson's reputation as 
a surgeon. During the war of 1812, he 
served as a surgeon with the Maryland 
troops, in 1814 he returned to Europe. 
He was present at the battle of Water- 
loo and was wounded at that battle. 

Dr. Gibson, described as a rapid and 
dexterous operating surgeon, was in- 
genious and creative. He was first in 
the country to perform suprapubic lith- 
otomy, and among the first to perform 
lithotripsy. He performed successfully 
a caesarean section on the same woman 
twice, saving the life of the woman and 
both children. Among his accomplish- 
ments were: inventing an apparatus for 
fractures of the lower jaw; creating a 
psuedoarthrosis of the knee joint for 
ankylosis and excised ribs; and divid- 
ing the recti muscles for strabismus as 
early as 1818. His reputation was en- 
hanced when he successfully extracted 
a rifle ball from Gen. Winfield Scott, 
who was wounded at the Battle of 
Lundy's Lane. 

A prolific writer, two years after ac- 
cepting the Chair at Maryland, Gibson 
brought out an American edition of "Dr. 
Charles Bell's System of Dissection." 
The two volumes were "dedicated to 
the gentlemen attending the University 
of Maryland." His writings continued 
after he left Maryland and in addition, 
he kept a daily journal for over 60 years, 
which at death, amounted to 150 vol- 
umes. 

Dr. Gibson was a clear and emphatic 
lecturer and his demonstrations of sur- 
gical anatomy were good, especially 
those relating to the neck, hernia and 
lithotomy. He had a large collection of 
models, casts, pictures, apparatus and 
surgical specimens which he used dur- 
ing his lectures and demonstrations. 

Dr. Gibson, a large and powerful man, 
round faced with a ruddy complexion, 
was athletic — an expert boxer, horse- 
man and trackman. He was vain of his 
personal appearance and proud of his 
reputation as a teacher and surgeon. 
An all around man, he played the violin; 
he was fond of botanizing and fishing; 
he was an ornithologist and amateur 
taxidermist, and he was vivacious and 
and possessed great stamina. 

In 1819 he was offered the Chair in 
Anatomy at the University of Pennsyl- 
vania, which he declined. So great was 



his reputation, however, and so eager 
was the faculty at Pennsylvania to have 
him, that the great surgeon, Physick, 
was displaced and Gibson was offered 
the Chair to replace this famous sur- 
geon. He accepted this appointment and 
left Maryland in 1819 — the boast of 
his student days had come true. 

His good work and fame continued 
throughout his stay in Philadelphia. He 
retired from the Chair at Pennsylvania 
and moved to Newport, R.I. While on a 
visit to Savannah, Ga., he died, appar- 
ently of a heart attack, March 2, 1868, 
age 80. 




granville s. pattison 



Granville Sharp Pattison (tenure 1820- 
26) was born near Glasgow, Scotland 
in 1792, the son of John Pattison of 
Kelvin Grove. He was educated at Glas- 
gow University where he was apparently 
a brilliant hard working student. At age 
18 he was made assistant to Professor 
Allan Burns and upon his death was 
appointed his successor to the Chair of 
Anatomy, Physiology and Surgery in 
Anderson Institution, a recently orga- 
nized but poorly endowed medical 
school at Glasgow. He became a licen- 
tiate of The Royal Faculty of Physicians 
and Surgeons of Glasgow in 1813. 

At Anderson Institution he gained 
quite a reputation as a lecturer and 
particularly as an anatomist. In Novem- 
ber 1818, charges were brought against 
him by Dr. Ure, one of his colleagues, 
of having committed adultery with his 
wife. Dr. Ure obtained a divorce. In 
December 1818, a letter arrived from 
Pattison's brother John, who lived in 



Philadelphia, advising him that there 
was probably an opportunity for a man 
of his talents at the University of Penn- 
sylvania, School of Medicine. The doc- 
tor arrived in Nev^ York from Liverpool 
July 7, 1819, but due to a shake up of 
the Pennsylvania faculty, did not get 
the Chair of Anatomy. The Chair was 
given to Dr. Philip Syng Physick. 

At the University of Pennsylvania Dr. 
Nathaniel Chapman developed a marked 
dislike for Pattison and began a ven- 
detta of maligning and debasement of 
him which lasted for years and eventu- 
ally caused a duel. Because of Chap- 
man's attacks, Pattison accepted no 
position at Pennsylvania and he also 
declined the offer of a professorship at 
Transylvania in Lexington, Ky. 

In 1820 at age 28, he was elected to 
and accepted the Chair of Surgery at 
the University of Maryland. Cordell re- 
ports Pattison as infusing new life into 
the University of Maryland. He suc- 
ceeded in disposing of his anatomical 
collection left to him by Professor Burns, 
to the University of Maryland for $8,000 
and a year later persuaded the faculty 
to accommodate it in a new $30,000 
hall, which later became a museum for 
over 1,000 selected morbid and healthy 
specimens. 

He was a colorful teacher, with a 
Scottish burr, radiating enthusiasm and 
confidence that charmed the students 
and increased the enrollment. He was 
not a good surgeon nor did he write 
many articles while in Baltimore. 

Pattison was a handsome, vain, well- 
dressed man, and quite a hit with the 
wives and debutantes of Baltimore, who 
oursued him with great success. Mean- 
MhWe, Chapman continued his attacks 
3n Pattison's character, which eventu- 
ally were more than Pattison would 
sndure. He went to Philadelphia and 
challenged Chapman to a duel. Pro- 
cessor Pattison declined because of 
age. His brother-in-law, Gen. Thomas 
3adwalader of Philadelphia, accepted 
:he challenge. Pattison and Cadwalader 
net in Delaware April 5, 1823 and Dr. 
John B. Davidge was present as sur- 
geon. Pattison shot the General in his 
'pistol arm," the ball traversing the 
3ntire length of the forearm, lodging 
n the ulna. Pattison escaped injury, the 



General's shot merely piercing the skirt 
of his coat. 

Many articles have been written about 
this duel and the story is "old hat" to 
nearly all graduates of the University 
of Maryland School of Medicine. 

Though Pattison may have been a 
roue, a rake, an adventurer and an in- 
famous character, he did one important 
thing to his credit. He championed bed- 
side clinical teaching, for which a hos- 
pital was needed. The Baltimore City 
Council and banks failed to extend more 
credit to the University. Pattison pre- 
vailed upon the faculty to extend their 
credit and build a hospital. The infir- 
mary which was situated on Lombard 
Street diagonally across from the medi- 
cal school was a four story brick build- 
ing and contained 60 beds. Ready for 
patients and classes by the Fall term 
of 1823, it cost the faculty $14,609 for 
construction, plus $2,520 for beds and 
furnishings. At the rear of the hospital 
was a semi-circular operation theater. 

Resident students could obtain room 
and board for $300 a year. The fee for 
patients for board, nurses and doctors 
was $3 per week. Pattison wrote to the 
Mother Superior of the Sisters of Char- 
ity at Emmitsburg, Md. October 11, 
1823 offering to place the management 
of the institution under the Sisters. The 
Sisters arrived shortly thereafter and 
ran the hospital from November 1823 
until 1876. This doubtless, thanks to 
Pattison, was the first "teaching hos- 
pital" in America. 

In the Summer of 1826, Pattison went 
to Europe and never returned to Balti- 
more. In 1827 he accepted the Chair of 
Anatomy at the University of London. 
He never was a success and complaints 
of his inability as a teacher and surgeon 
increased to the point that in 1820-31 
"his colleagues offered to pay him a 
certain stipend for a number of years 
if he would retire." He was literally 
"drummed out" of the University July 
23, 1832. 

The doctor returned to America in 
1832 having been elected to the Chair 
of Anatomy at the new Jefferson Medi- 
cal College in Philadelphia. He re- 
mained at Jefferson until 1841, when 
he resigned to join in the founding of 
the Medical Department of the Univer- 
sity of New York. For the next ten years 



37 



he remained at the University of New 
York as Professor of Anatomy until his 
death November 12, 1851. His death 
was due to complications from obstruc- 
tion of the common bile duct. 

Granville S. Pattison, a truly attractive, 
colorful and tempestuous figure, about 
whom much is written, did little or 
nothing to advance the progress of 
surgery. He was a poor and unimagina- 
tive surgeon and not creative in that 
field. His writings were limited to the 
editing of several hundred anatomical 
volumes. Pattison's greatest contribu- 
tion to medicine was his conception and 
implementation of a teaching hospital 
for medical students. 




nathan r. smith 



Nathan R. Smith (tenure 1827-69) the 
famous second son of a famous father, 
Dr. Nathan Smith, was born at Cornish, 
N.H., May 21, 1797. His elementary edu- 
cation was received from private tutors 
and at Dartmouth College. His father, 
Nathan Smith, the founder of Dartmouth 
Medical College in 1798, resigned from 
that institution in 1813 to head the fac- 
ulty of the Yale Medical School at New 
Haven. Nathan Ryno left New Hampshire 
with his father and matriculated as a 
freshman at Yale in 1813. He received 
the A.B. degree in 1817, at the top of his 
class. Following graduation he spent 
18 months as a tutor for the family of 
Thomas Turner, a Virginia gentleman of 
wealth and social eminence. During this 
short period he developed a strong 
attachment for the South, which lasted 
his entire life. (Much later in life at age 
72, he wrote a short discourse "Legends 



of the South, by Somebody, who wishes 
to be considered nobody"). After this 
sojourn in Virginia, he entered Yale 
Medical School and received from Yale 
College the M.D. degree in 1820. His 
inaugural thesis defended the view, 
"that the effects of remedies and dis- 
ease are the result of absorption from 
the blood stream and not an impression 
on the nervous system." His interest in 
this subject continued with experiments 
that were published in 1827. 

Dr. Nathan Smith, a founder or co- 
founder of several medical schools, 
(Dartmouth, Yale, Bowdoin, Vermont, 
Jefferson) together with his son, Na- 
than Ryno, founded the University of 
Vermont at Burlington in 1820. Dr. N. R. 
Smith was appointed to the Chair of 
Anatomy and Surgery in 1824. Before 
taking over these positions, he took 
leave to attend lectures at the Univer- 
sity of Pennsylvania, to better prepare 
himself. While in attendance, he met 
Dr. George McClellan and others, who 
were busily engaged in founding Jeffer- 
son Medical College. These men were 
impressed with young N. R. Smith and 
offered him the Chair of Anatomy, 
which he accepted. In 1827, after two 
years at Jefferson, he was offered the 
Chair of Anatomy at the University of 
Maryland. Dr. Davidge was then Acting 
Professor of Surgery, following Patti- 
son's resignation. An exchange was 
effected whereby Smith became Profes- 
sor of Surgery and Davidge returned to 
the Chair of Anatomy. 

Dr. N. R. Smith, a good six feet tall, 
was a man of commanding, if not dom- 
ineering presence. He was clean shaven, 
with a Grecian nose, piercing eyes, 
shaggy eyebrows and very erect pos- 
ture. He usually dressed in a neat black 
frock coat. He was myopic and wore 
glasses. It was this young dignified 
gentleman of 30 years, that with great 
enthusiasm, industry and ability, took 
over the Chair where he was to remain 
over the next four decades. 

Upon arrival at Maryland, he had but 
one competitor in Baltimore, a Dr. 
Jameson. Smith's efforts were so vig- 
orous and noteworthy, however, that 
he soon had the surgical practice of 
Baltimore and Maryland at his disposal. 

Smith prepared his lectures with 
great care and delivered them without 



notes, in a slow deliberate fashion. He 
possessed and frequently indulged in 
humor and clean stories to the delight 
of the students. At times, he carried a 
pointer or teaching stick, which he 
snapped against his trousers. No wonder, 
with his regal carriage, deep set eyes and 
bushy brows, he was nicknamed "The 
Emperor." Such a stern countenance 
as he possessed, was sure to command 
the undivided attention of the audience. 
His lectures dealt with inflammation, 
wounds, burns, ulcers, kidney and blad- 
der stones, aneurysms, amputations, 
tumors, and a great variety of subjects 
now claimed by the specialties. He had 
a creative and fertile mind, not shackled 
by dogma. His was the glamour course 
at the Medical School and many stu- 
dents opted to take it a second time, so 
impressed were they by the master. His 
demonstrations of pathological mate- 
rial at lectures was an outstanding 
attraction. 

He continued to gain in stature over 
the years — locally and along the east- 
ern seaboard. Overlooked by most of 
his biographers, is an outstanding sur- 
gical procedure he performed in 1835. 
A Mrs. M. Wells from Prince George's 
County, came to him for the third or 
fourth time, requesting him to operate 
for an ulcerating goiter. Together, with 
Dr. Potter and others, after having 
warned the patient repeatedly of the 
dangers, he decided to operate. The 
operation was performed in less than 
one hour through a vertical incision, 
without anesthesia. All of the structures 
encountered were minutely described in 
his operative note. Unfortunately, the 
patient died thirteen days after the op- 
eration from sepsis. This was the first 
operation for goiter ever performed in 
Maryland, and the second such opera- 
tion performed in America. This under- 
taking is more evidence of his courage 
and ability as a surgeon, because doubt- 
less he had no mentor to show him 
the way. 

Several years after his appointment, 
there was much unrest in the University 
as to its administration, until finally in 
September 1837, the Board of Regents 
of the University, the governing body 
of the University, was dismissed and 
replaced by action of the State Legis- 
lature, by a Board of Trustees. Smith, 



siding with the Regents, withdrew from 
the University of Maryland and accepted 
a Chair of Practice of Medicine in 
Transylvania University at Lexington, 
Ky., which at that time, was the leading 
medical school of the West. Another 
famous surgeon of the era, Dr. Benjamin 
Dudley, was then Professor of Surgery 
at Transylvania. For three years he 
traveled west each fall, returning to 
Baltimore to his practice and family 
after the four month session. His salary 
was recorded at $3,000 a year for the 
session. The Transylvania catalogue of 
1838 notes that he was touted as one 
of the outstanding surgeons of America. 

During these three years the Univer- 
sity of Maryland had recovered from its 
administrative difficulties, and Smith 
agreed to resume his Professorship of 
Surgery at Maryland, which he held un- 
til retirement in 1869. For this long pe- 
riod 1841-69 "The Emperor" continued 
to dominate the profession of Maryland. 
His fame was such that the illustrious 
Henry Clay was a guest in his home 
and he was an acquaintance of Daniel 
Webster. 

As a surgeon he was gifted with 
"dexterity, speed, great acuteness of 
perception and an unusual power of 
adaptation to unusual circumstances." 
During his tenure, anesthesia was in- 
troduced and he was quick to adopt 
it, as he was other new techniques in 
surgery. Smith invented his own litho- 
tome but regarded his anterior splint for 
fractures of the lower extremities, as 
his greatest medical contribution. This 
splint was perfected in 1860 and was 
so popular, it was adopted here and 
abroad. His thyroidectomy, it seems 
should have received more notice. 

A prolific writer, he contributed many 
articles to the Journals in Maryland, 
Pennsylvania, Virginia and the Ameri- 
can Journal of Medical Sciences. In 
1832 he published a book on the "Sur- 
gical Anatomy of Arteries," which was 
republished as a second edition in 
1835. In 1867 he published a small 
monograph on the "Anterior Suspensory 
Apparatus in the treatment of fractures 
of the lower extremity." He received 
acclaim from famous surgeons in Eu- 
rope in 1867, including Sir James Paget 
and Spencer Wells. He received the 
degree of L.L.D. from Princeton in 1862. 



39 



Dr. Smith was truly one of the sur- 
gical giants of his era and did more 
than anyone on the faculty to give pres- 
tige to the Medical School. He retired 
from the Chair in 1869 and the following 
year was elected President of the Med- 
ical and Chirurgical Faculty. His last 
years were spent with office practice, 
reading and writing. Dr. Smith died at 
age 80, July 3, 1877 of bladder disease 
and the infirmities of old age. 




Christopher Johnston 

Christopher Johnston (tenure 1869- 
80) was born in Baltimore, September 
27, 1822. He was educated at St. Mary's 
College in Baltimore and at St. Mary's 
College in Cincinnati, Ohio. He began 
the study of medicine under the pre- 
ceptorship of Dr. John Buckler of Bal- 
timore. 

He spent a great deal of the time in 
his student days at the Baltimore Alms- 
house. He was awarded the M.D. de- 
gree from the University of Maryland 
School of Medicine in 1844. After grad- 
uation he went to Europe for further 
study. This was the first of five visits 
to that continent. 

Upon return he and Dr. Frick founded 
the Maryland Medical Institute, a pre- 
paratory school for medicine. He left 
again for Europe in 1853 and remained 
two years, studying in the clinics of 
Paris and Vienna. During that time he 
acquired great skill in using micro- 
scopes and later became lecturer and 
demonstrator at the University on "Ex- 
perimental Physiology and Microscopy." 
He relinquished this post two years 
later to become Professor of Anatomy 
at the Dental College, where he served 



for seven years. In 1864, he accepted 
the position of Professor of Anatomy 
and Physiology in the Medical School. 

As a result of hiis excellent care of 
the Southern wounded at the Battle of 
Gettysburg, his fame and practice 
greatly increased among the people of 
Baltimore. It is of interest to note he 
became a friend of the celebrated actor, 
Edwin Booth. When Booth had his arm 
pierced in the fencing scene in Hamlet, 
Johnston was called to care for him. 
On the night following the injury, Booth 
played Richard III at Fords Grand Opera 
House with his arm in splints. 

In 1869 at the age of 47 he succeeded 
Dr. N. R. Smith as Professor of Surgery 
and held the Chair for the next eleven 
years. 

A slow and meticulous surgeon, 
Johnston was particularly sensitive to 
cosmetic effect. As a matter of fact, his 
longest paper was the section in Ashurts 
International Encyclopedia of Surgery 
on "Plastic Surgery." The scholarly 
paper of eighteen pages had a lengthy 
bibliography, but did not report any 
experience that the author had with this 
specialty. 

Johnston was credited with being the 
first surgeon in Maryland to completely 
excise the upper jaw (1873) and the first 
to perform surgery for vesicle exstrophy 
(1876). He was active in the small med- 
ical and scientific societies and served 
as president to several. 

At the age of 58 he resigned at Mary- 
land but continued actively to practice 
surgery. After succeeding Dr. N. R. 
Smith, he was the acknowledged leader 
of the surgical profession in Baltimore 
from 1870 to 1890. He continued travel- 
ing in Europe and became master of 
the French and German languages. 

When Johns Hopkins Hospital opened 
he was appointed Consulting Surgeon. 
He became enamored of this new insti- 
tution, its laboratories, museums and 
libraries, so much that he forgot his 
alma mater. Despite the fact that he 
received his M.D. from Maryland, on 
his death, he left his instruments, micro- 
scopic apparatus, his cabinet of crys- 
tals and entire library to the Johns 
Hopkins University. 

After some months of poor health, 
he died October 11, 1891 at age 69. 



faculty news 

buxton scholarship 



The Senior Class, School of Medicine, 
has established a scholarship fund in 
memory of the late Dr. Robert W. Bux- 
ton, chairman. Department of Surgery. 

Paul Rogers, class president, said, 
"Initially the Senior Class contributed 
$2,500 from the treasury to establish 
the medical school's new scholarship 
fund. In addition the class sent letters 
to faculty, parents and friends asking 
for contributions. Hopefully, other grad- 
uating classes as well as members of 
the 1971 class will make future con- 
tributions." 

Donations will be put into a special 
account in the University's General En- 
dowment Fund with the principle re- 
maining in the Fund while the interest 
is used for an annual scholarship. 

Dr. Frederick J. Ramsay, assistant 
dean, Student Affairs, will be responsi- 
ble each year for selecting the recipient 
of the scholarship. He will also make 
an annual accounting of money used 
from the fund. The only restriction is 
that the scholarship must be given a 
student based on financial need. 

Those wishing to contribute to the 
fund should make checks payable to 
the "Dr. Robert W. Buxton Scholarship 
Fund" and mailed to the Dean's Office, 
University of Maryland Medical School, 
Lombard and Greene Sts., Baltimore, 
Md. 21201. 



outstanding faculty 



Nine members of the School of Medi- 
cine faculty have been honored by the 
Student Council for demonstrating an 
outstanding quality of inspirational guid- 
ance and interest in teaching and prac- 
tice of medicine. 

Peter Vash, Student Council presi- 
dent, explained that each year the 
Council selects a single faculty member 
whom they felt to be most deserving 
and present him or her with a plaque 
at a dinner held in his or her honor. 



"This year the Council altered the 
procedure," said Vash. "We felt that in 
any one year there is often several 
faculty members and house staff who 
have demonstrated an outstanding in- 
terest in the teaching and guidance of 
students. Moreover, we feel that there 
are many faculty or house staff whose 
diligent and conscientious teaching 
abilities all too frequently go unac- 
knowledged." 

The following were honored at a din- 
ner held at the home of Dean John H. 
Moxley III: Marshall L. Rennels, Ph.D., 
assistant professor, Anatomy and Neur- 
ology; Charles C. C. O'Morchoe, M.D., 
Ph.D., associate professor. Anatomy; 
Mary E. Kirtley, Ph.D., associate profes- 
sor. Biochemistry; David B. Ludlum, 
Ph.D., professor. Cell Biology and Phar- 
macology; Donald Pachuta, M.D., fellow, 
Infectious Diseases; William Holden, 
M.D., clinical assistant professor. Psy- 
chiatry; Robert L. Derbyshire, Ph.D., 
associate professor. Sociology in Psy- 
chiatry, and director. Division of Urban 
Studies and Group Process; William L. 
Stewart, M.D., associate professor and 
head. Division of Family Medicine; and 
Stuart H. Walker, M.D., professor. Pedi- 
atrics. 



O 

I 



DR. ELIJAH ADAMS, professor of Bi- 
ological Chemistry, has been awarded a 
Guggenheim Fellowship for 1971. The 
fellowship is for "Experimental Studies 
in Synthesis of Peptides." There were 
2,363 applications for the fellowships 
of which 354 fellows were selected in 
the U.S. and Canada. Dr. Adams is cur- 
rently on sabbatical leave at Weizmann 
Institute of Science at Rehovat, Israel. 



41 



DR. MARTIN HELRICH, professor and 
chairman of the Department of Anesthe- 
siology, has been appointed chairman 
of the Advisory Committee of the Food 
and Drug Administration. 

DR. MORRIS J. WIZENBERG, profes- 
sor of Radiology and head of the Divi- 
sion of Radiation Therapy, has been 
elected president of the IVIaryland Divi- 
sion of the American Cancer Society. 

DR. JONAS RAPPEPORT, associate 
clinical professor of Psychiatry, has 
been re-elected president of the Ameri- 
can Academy of Psychiatry and the 
Law. 

DR. MAXWELL WEISMAN, clinical in- 
structor of Psychiatry, was appointed to 
serve on the National Advisory Com- 
mittee on Alcoholism. 

DR. ARTHUR L HASKINS, professor 
and head of the Department of Ob- 
stetrics and Gynecology, has been 
elected president of the Association of 
Professors of Gynecology and Ob- 
stetrics. 

DR. EDUARD ASCHER, associate 
clinical professor of Psychiatry, is the 
recipient of a special award by the 
American Group Psychotherapy Asso- 
ciation for "meritorious contributions as 
an instructor to the Association's 
Institutes." 




DR. LEONARD SCHERLIS, professor 
of Medicine and head of the Division of 
Cardiology, has received an award of 
merit from the American Heart Associa- 
tion. In citing Dr. Scherlis for his work 
Dr. William W. L. Glenn, president of 
the association, said the Maryland 
physician is "a godfather of our cardio- 
pulmonary resuscitation program and 



of our heart sounds screening program. 
Few physician-volunteers have contrib- 
uted more in time, effort and results to 
our community programs . . ." 

DR. JAMES J. LYNCH, associate di- 
rector of Psychiatry, has been named a 
consultant to the American Psychiatric 
Association's Task Force on Behavioral 
Therapy. The task force will analyze 
behavioral therapy and attempt to in- 
corporate it into the medical curriculum. 

DR. FRANK RAFFERTY has been ap- 
pointed director of the Institute for 
Juvenile Research and professor of 
Child Psychiatry, University of Illinois 
School of Medicine, Chicago, effective 
in either July or September. Effective 
July 1, Dr. Taghi Modarressi assumed 
the position of acting director of Child 
Psychiatry. 

DR. EUGENE B. BRODY and DR. 
ARTHUR LAMB have been appointed 
to the Advisory Committee to the De- 
partment of Psychiatry, Sinai Hospital. 

DR. NATHAN SCHNAPER, associate 
clinical professor of Psychiatry, has 
been appointed by the State Board of 
Education as a member of the Medical 
Advisory Committee for the Division of 
Vocational Rehabilitation for a term of 
three years. 

DR. ERLAND NELSON, professor and 
head of the Department of Neurology, 
has been awarded a $21,000 grant from 
the National Institute of Neurological 
Diseases and Stroke to continue his 
electron microscopic studies of the in- 
nervation of brain arteries. He was also 
appointed to the Editorial Board of the 
Journal of Neuropathology and Experi- 
mental Biology. 

DR. ARLIE MANSBERGER, acting 
head of the Department of Surgery, has 
announced the following new appoint- 
ments to the department: Dr. Lary 
Becker, Dr. Ranier M.E. Engel, Dr. 
Richard A. Currie, Dr. Liebe S. Dia- 
mond, Dr. Philip J. Ferris, Miss Madeline 
Fox, Dr. Magdi G. Henein, Dr. Sidney 
Marks, Dr. Gary L. Nobel, Dr. Ronald 
L Paul, Dr. Herbert Schwarz and Dr. 
Gardner Smith. 

LAWRENCE DONNER, Ph.D., assist- 
ant professor of Clinical Psychology, 
Department of Psychiatry, was elected 
Representative at Large by The Mary- 
land Psychological Association, April, 
1971. 




/illem G. A. Bosma, M.D. 



In 1968, the Maryland legislature 
passed the first comprehensive Alco- 
holism Rehabilitation Act in the whole 
country, and It now has the most ad- 
vanced and imaginative statewide treat- 
ment program in the United States. 

The law in Maryland hopes to effect 
three basic changes in the treatment of 
alcoholics. Implicit in it is the idea that 
alcoholism is a medical problem: alco- 
holics are sick people. The first major 
step then, is to take the care of alco- 
holics out of the hands of law-enforce- 
ment agencies. 

Alcoholism has to be fully accepted 
as a public health problem and not, 
hitherto, primarily a law enforcement re- 
sponsibility. Traditionally, across Mary- 
land, some considerable percentages of 
alcoholics have been managed by law 



enforcement and correctional agencies 
and institutions. A study in 1965 showed 
that approximately one-eighth of the 
State's estimated alcoholics had been 
so managed. A positive alcoholism pro- 
gram must begin by replacing that old 
system of management by a different, 
more productive system under health 
and social service direction. 

The second desired change in treat- 
ment is for the care of alcoholics to be 
taken out of state mental hospitals. For 
30 years state mental hospitals have 
been the major, almost the only, treat- 
ment resource for Maryland's alcoholics, 
a patient load they are not equipped to 
handle. 

Because alcoholism is a massive 
community problem, alcoholism pro- 
gramming must emphasize decentral- 



Dr. Bosma, Director of Alcoholism Programs, University ot Maryland School of Medicine, presented 
a paper "Alcoholism and Drug Dependence in Maryland" recently at the First British International 
Conference on Alcoholism and Drug Dependence. This is an excerpt from the paper. 



43 



ized, local, community service, and 
de-emphasize State control and insti- 
tutionalization; the alcoholic must be 
treated where he lives and works, pre- 
ferably as an out-patient. 

Alcoholics can and should be treated 
in the mainstream of health and social 
welfare, along with other sick and 
troubled people, and specialized serv- 
ices be limited to those not already 
provided by existing health and social 
agencies. 

Leadership for alcoholism program- 
ming should properly be a function of 
the local health department, and full- 
time specialized personnel should be 
added to the local health department 
staff. In Maryland, every local health 
department except one has such spe- 
cialized personnel. And, every health 
center should make its full range of 
services available to alcoholics, pre- 
ferably by addition of alcoholism coun- 
selors to its staff. 

Dedicated non-professional help to 
sick alcoholics and their families, serv- 
ices to alcoholics in both general and 
specialized agencies can and should be 
provided by non-professionals, with 
little or no drain on the professional 
personnel market. 

However, public health programs are 
needed for certain functions that can't 
be achieved by other agencies: for case 
finding and early diagnosis, for ex- 
ample; for social management of alco- 
holics already totally bankrupt physi- 
cally, mentally, spiritually, economically 
and socially; for medical and nursing 
care for the alcoholic in crisis; for pro- 
fessional training, and for research. 

Thirdly, because it is clear that public 
and private "helping people" are not 
presently prepared to help alcoholics 
and their families, that most of them are 
indeed uninformed or misinformed about 
alcoholism and its victims, top priority 
in the Maryland program is given to 
(1) preparing them by educational pro- 
grams to take on their respective re- 
sponsibilities; and (2) introducing alco- 
holism content into the curricula of all 
professional schools. 

In the history of almost every alco- 
holic are accounts of periodic searches 
for help, of desperate appeals to physi- 
cians, hospitals, clergymen, teachers, 
and others — and of meeting with rejec- 




tion. To prevent such breakdown of 
understanding, alcoholism programs 
must work to correct the ignorance and 
prejudice of professional workers when 
dealing with alcoholics, and give them 
expert advice with which to aid alco- 
holics, so that the latter can find what 
they need when they need it. 

If all the thousands of people, such as 
doctors, nurses, and social workers, 
who make their living in the helping 
professions were prepared to identify 
and help alcoholic individuals and 
families, there would be no "hidden 
alcoholics." 

For the last year, work has been 
under way to develop an interdiscipli- 
nary curriculum on Alcoholism and Drug 
Abuse for the six post-graduate profes- 
sional schools of the University of 
Maryland: the Schools of Medicine, 
Social Work, Law, Nursing, Dentistry 
and Pharmacy. This is the first major 
effort in the U.S. to introduce alcoholism 
content courses into professional 
schools. The attitude of the students to 
the seminars and field work has been 
most favorable, but some of the admin- 
istrations have often been reluctant. The 
latter reflect all the attitudes of profes- 
sional people and society at large — 
attitudes which we have to change if 
alcoholics are to get the care they 
deserve. 

Such a turn-about In attitudes pre- 
sents a major challenge to professional 
institutions. Much has been done since 
enactment of the 1968 law, but even 
more needs to be done. The difficulties 
have been compounded by the fact that 
only limited funds have been made avail- 



able by the State of Maryland. The 
people of the Division of Alcoholism 
Control have had to concentrate on 
getting the cooperation of existing 
health and social facilities. When these 
have not been sufficient, limited new 
ones have been established, mainly a 
variety of residential facilities for alco- 
holics. 

University Hospital illustrates how an 
existing health facility has been pressed 
into the service of providing treatment 
for alcoholics. The 600-bed facility 
which is not only a service but also a 
teaching hospital, contains patients 
from all walks of life. 

The basic attitude at the hospital is 
that treatment processes with the 
highest incidence of success are those 
that tailor treatment to the individual 
needs and resources of the alcoholic 
patient. Thus, an alcoholic is met in the 
Emergency Room by a counselor who 
acts as a screening agent. Together with 
the doctor on call, he decides where 
the patient will go for treatment. Some 
need to go to medical, surgical, psychi- 
atric or other specialized services, but 
while on these services, they are also 
r-een by alcoholism counselors. If the 
patient does not require any service 
within the hospital, and has no home to 
go to, or is too sick to go home but not 
sick enough for the hospital itself, he 
can be referred to the Quarterway 
House. This resident facility is five min- 
utes from the hospital and all the serv- 
ices of the hospital are available to it. 
Doctors make weekly rounds in this 
20-bed facility. The average cost per 
alcoholic is $5 per day as opposed to 
$70 per day in a hospital. 

In the Quarterway House, the alco- 
holic is first detoxified and if necessary, 
made comfortable with some mild tran- 
quilizers. He is then actively involved in 
a program of education, personal and 
group counseling, therapy and voca- 
tional rehabilitation. Families and rela- 
tives are whenever possible, involved in 
the treatment program. The pros and 
cons of disulfiram, antabuse, are pre- 
sented to him. Many choose this as an 
adjunct to staying sober. 

The alcoholic stays two weeks in the 
Quarterway House. He is then referred 
to the Out-Patient Clinic at University 
Hospital, and if he is on antabuse to the 



Antabuse Group, which meets weekly in 
the Quarterway House. Two alcoholic 
counselors make regular home visits 
and help the patient avail himself of 
treatment facilities in his neighborhood. 
If the patient is well enough after 
having been seen in the Emergency 
Room of the hospital, where he some- 
times stays up to 24 hours, he can be 
sent home. From there an effort is made 
to involve him in the various treatment 
facilities in his neighborhood, such as 
open or closed groups, out-patient 
psychiatric services, personal counsel- 
ing, after-care clinics, etc. 

If a patient has nowhere to go he can 
be referred to the Shelter, a 1 20-bed 
facility. The Shelter takes Skid-Row 
alcoholics and provides them with a 
bed, a meal, and some counseling. They 
do not have to stop drinking, however, 
but it does seem to reduce the amount 
they drink. This facility, for what is re- 
ferred to as the "chronic alcoholic," is 
a most helpful one. Previously, the 
chronic alcoholic had been referred to 
other agencies, where the assumption 
was that he would stop drinking. Neither 
party benefitted from this arrangement 
and this rather hopeless patient tended 
to "clog-up" the facilities so much 
needed for patients with better pros- 
pects. 

The Half-way Houses are for re- 
covered alcoholics with a job who need 
an interim supportive environment until 
they are able to go out on their own. 
Half-way Houses are self-supporting as 
the patient pays room and board. 

It is clear that treatment facilities, 
and this goes for all large-scale pro- 
grams in the United States, is still based 
on rather ineffective treatment modal- 
ities. Only 35 to 50 per cent of the 
patients benefit from it. Intact, there is 
still no definite treatment for alcoholism. 
Individual or group psychotherapy, 
counseling, antabuse and membership 
in Alcoholics Anonymous are still re- 
garded as the only hope of cure. 

In the meantime, many clinicians are 
desperately seeking more successful 
treatment methods, including condition- 
ing and the use of L.S.D.; up until now, 
without success. It is clear that there is 
still a long way to go in the treatment of 
what is considered America's number 
one health problem, health sciences ubrary45 

UNIVERSITY OP MARYLAND 
BALTIMORE 



alumni day 1971 



Alumni Day activities this year began 
with registration in the entrance of 
Davidge Hall at 10 a.m. June 3 and was 
followed by a report to the Alumni. 

Dr. Theodore Kardash, president of 
the Medical Alumni Association, wel- 
comed this year's attendees. 

Dean John H. Moxley III spoke to the 
Alumni about the assets of the School 
of Medicine and some of its problems. 
Following the Dean's presentation, Dr. 
Karl Weaver, associate dean for admis- 
sions, and Dr. Frederick J. Ramsay, 
assistant dean for student affairs, spoke 
on "Student Selection Policies," and 
"Curriculum Changes," respectively. 
Senior medical student, Robert Shannon, 
addressed the group on "Changing 
Medical Education." 

A special guest speaker was Charles 
E. Hackett, vice president. Colonial 
Williamsburg, Williamsburg, Va. He com- 
mented on the "Davidge Hall Restora- 
tion Plan." 

At noon the annual business meeting 
convened. Dr. Kardash opened the meet- 
ing with the presentation of the Gold 
Key award to Dr. W. Houston Toulson 
'13. 




"This honor which you have been kind 
enough to bestow on me today has 
affected me deeply. I am gratified by 
this very fine touch and appreciate it 
immensely," said Dr. Toulson in ac- 
cepting a plaque and the traditional 
gold key. 




Dr. M. E. Shamer '10 

Dr. Arlie Mansberger '47 presented 
the annual financial statement: 

MEDICAL ALUMNI ASSOCIATION 
FINANCIAL STATEMENT 



April 30, 1971 




* Assets in Bank Accounts 


$25,532.27 


* Assets in Investments 


43,000.00 


Assets in University of 




Maryland account 


1,206.11 


Assets in Petty Cash 


40.34 




$69,778.72 


Receipts April 1-30, 1971 


1,406.99 




$71,185.71 


Disbursements April 1-30, 




1971 


2,094.80 


BALANCE 


$69,090.91 



* Includes Davidge Hall Fund 

The annual election of officers fol- 
lowed and presentation of the slate 
recommended by the nomination com- 
mittee was by Dr. Lewis P. Gundry'28. 
The following were elected: 
President: Dr. Edward F. Cotter '35 
President-elect: Dr. Henry H. Startzman 

Jr. '50 
Vice-president: Dr. John H. Hornbaker 

'30 

Dr. Benjamin M. Stein '35 

Dr. William S. Womack '48 
Secretary: Dr. Robert B. Goldstein '54 
Treasurer: Dr. Arlie Mansberger '47 



Executive Director: Dr. William H. Trip- 

lett'11 BMC 
Executive Administrator: Francis W. 

O'Brien 
Executive Secretary: Louise P. Girken 
Members of Board: Dr. William J. R. 

Dunseatli '59 

Dr. William H. Mosberg Jr. '44 

Dr. Charles E. Shaw '44 

Dr. Joan Raskin '55 

Dr. Donald T. Lewers '64 

Dr. Cliff Ratliff '43 

Dr. Joseph 8. McLaughlin '56 

Dr. Aristides Alevizatos '60 

Dr. John F. Strahan '49 
Ex-officio Members of Board: Dr. Wil- 
fred H. Townshend Jr. '40 

Dr. Theodore Kardash '42 

Dr. John H. Moxley III, M.D. 
Elected to the Nominating Committee: 

Dr. Raymond Cunningham '39 

Dr. Gibson Wells '36 

Dr. J. Howard Franz '42 




Dr. O. C. Mandry '21 & Dr. E. A. P. Peters '21 

Dr. Raymond Cunningham submitted 
for consideration by the alumni group, 
an idea to have eight members on the 
nominating committee representing 
various hospitals in Baltimore who have 
alumni practicing in the institution plus 
the two past presidents, who are ex- 
officio. He also suggested that no one 
be considered for president or presi- 
dent-elect of the association unless he 
had served on the board of directors. 
Both of his suggestions will be taken 
up at a later date by the Alumni Board 

As has been the custom in years past, 



the names of classmates who died dur- 
ing the past year were read by Dr. 
William H. Triplett '11 BMC and a 
moment of silence prevailed in honor 
of these deceased. 




Dr. J. H. Horrjbaker '30 & Dr. M. J. Skovron'31 register. 

Dr. Kardash in reporting what had 
occurred during his year as president 
said that the current alumni active en- 
rollment was approximately 2,300 and 
that "with these figures there's still 
room for more." 

Two of the most important aspects of 
his term in office were the launching 
of the Davidge Hall restoration fund and 
reorganization of The Bulletin. 




"Plans for the restoration of Davidge 
Hall went ahead under the direction of 
Dr. Sharrett with some $45,000 made 
in cash and pledges in the first six 
months. The goal is over $800,000 
which we hope to reach by 1975 when 
the Alumni Association will be 100 
years old," Dr. Kardash remarked. 

In reference to the Bulletin reorgani- 
zation he said, "For the first time great 
guidelines of responsibility have been 
established for the Editorial Board, the 
Editor and the Managing Editor. The 
Dean and the Alumni Association will 



47 



endeavor to keep the alumni well in- 
formed concerning the activities of the 
school, its faculty, its students and 
other alumni. We are looking forward 
to having a Bulletin that we all can be 
proud of which is a quality magazine 
that will be interesting, provocative, in- 
formative and inspiring." 

Dr. Edward F. Cotter was then intro- 
duced as the new president of the Med- 
ical Alumni Association. 




"It will be an honor and privilege for 
me to serve as your president next 
year. I hope that I can bring to the office 
the same dedication as Dr. Kardash 
and presidents who preceded him. As 
president, I will help preserve the many 
traditions of the school, but certainly 
not the rigidity that will prevent changes 
which we see in our social, political 
and economic structure as inevitable," 
said the new president. 

Cotter then asked the alumni for in- 
creased participation and said he would 
always welcome suggestions. 

There was no new business so the 
meeting adjourned and the alumni 
luncheon was held in the Psychiatric 
Institute gymnasium. 






review 



John h. moxley III 

In general, I think that I can report a 
good year to you. It certainly has not 
been perfect, but I believe good. There 
are problems at this medical school, 
but none I believe are unique to Mary- 
land. These problems are shared by all 
medical schools today. As a matter of 
fact, university medical centers are cur- 
rently the focus of at least three irre- 
concilable forces; mainly, the student 
body, the faculty and the community. 

Students are feeling the effects of 
growing up in an age of very rapid 
change; growing up in a period in which 
our society is being somewhat de- 
humanized by advances in technology 
and science. 

The faculty is also trying to come to 
gripes with change. Again it's a change 
in our society which at least tempo- 
rarily, is becoming less interested in 
the creation of new knowledge and 
more in the application of existing 
knowledge. This is a significant change 
in the ground rules under which we've 
lived for the past 20 years. Although it 
was a needed change, the dimensions 
of the change are unfortunate, because 
while I am service-oriented, I think that 
it is unfortunate to dismantle even in 
part, a medical research effort that has 
produced really fantastic amounts of 
new knowledge. 




And, the final force that is bearing 
upon every medical school in the coun- 
try is the community in which they 
reside. We reside in an urban com- 
munity largely inhabited by poor people. 
Largely populated by black citizens 
who view us primarily as a purveyor of 
health services. They as a part of the 
consumer revolution are insisting that 
we provide more health services and 
better health services. And this gives 
rise to some problems. All of these 
forces are legitimate, but sometimes it 
seems almost impossible to get them 
going on the same track in the same 
direction. 

Now, for discussion of several spe- 
cific problem areas which are facing 
us and to bring you up to date on what 
has happened at the school in the last 
year. I will begin with the financial pic- 
ture of the school. 



49 



Last year, I was able to report that 
the school had made a significant ad- 
vance in the level of its state support. 
This year the results have not been so 
favorable. The budget was prepared 
with very carefully thought out askings, 
was approved on this campus and sent 
to College Park. Between then and its 
submission to the Legislature, it was 
decided that the University would be 
funded this year by a formula method. 
The same formula was applied to all 
schools within the University, and as 
you can imagine the results were dis- 
astrous. The Medical School budget 
was cut more than any other single 
school in the University — it was cut by 
over two-thirds. 

There also has been a great change 
in the pattern of funding of medical 
education in this country. The Federal 
Government has been cutting back 
significantly on some of the grants that 
went to medical schools and individual 
faculty members. Dr. Rogers, the Dean 
at Hopkins, and I approached the Gov- 
ernor in mid-summer to inform him that 
this was reaching critical proportions 
and indeed both medical schools might 
be in danger if something wasn't done 
to correct this situation. The Governor 
submitted a special $2 million appro- 
priation for medical education which 
was to be divided on a per capita basis. 
The University of Maryland would have 
gotten $1.2 million and Hopkins would 
have gotten $800,000. 

Again changes were made before 
reaching the Legislature. It was decided 
that the Maryland portion would be re- 
moved from the special appropriation, 
increased to $11/2 million and given as 
a special appropriation to the entire 
University, not just to the Medical 
School. Of that special appropriation, 
we netted a few hundred thousand dol- 
lars which brought us up to approxi- 
mately 50 per cent of what we had 
initially asked. 

Then the Legislature cut the Hopkins 
portion. The last day of the Legislative 
session, it was too late to add to our 
operating budget, the Governor and 
Sen. James did manage to get $400,000 
into the capital budget earmarked for 
the medical school. Now we can re- 
model the fifth floor of Howard Hall 
which is essential to our expansion pro- 
gram. At the same time they managed 




to get Hopkins' portion of the special 
appropriation re-instated. However, we 
are still significantly below what we 
thought was reasonable for the growth 
and expansion of this medical school. 

In terms of expansion, we have ex- 
panded by some 37 places over the 
period of less than a decade. That may 
not seem like a great number, but in 
medical education with the expense 
and the resources necessary it is a 
fairly large number. Over two years ago, 
the medical faculty in a public report, 
made the commitment to go to an enter- 
ing class size of 200 as soon as the 
resources were made available. We are 
anxious to meet that commitment, but 
we cannot expand this school on the 
basis of an inadequate budget for the 
number of students that we are cur- 
rently teaching. 

The resources have not been forth- 
coming for us to move ahead. We will 
need some further capital expansion 
and a significant increase in our oper- 
ating budget. At the present time, we 



ire beginning to put together another 
expansion program which will probably 
Ue submitted to the Legislature next 
tear. A detailed plan for expansion to 
boo students per year will be submitted 
Lich will line up for them as many 
kptions as we can. These include where 
fhe Federal Government is liable to 
oarticipate and where they won't par- 
ticipate, and what the delay may be if 
we wait for Federal funding rather than 
going straight forward with State fund- 
ing. 

I want to emphasize for you that the 
commitment to expand is here. 1 always 
seem to receive questions you haven't 
expanded in the last 20 years and that 
is not so. This school has expanded as 
rapidly as any other medical school in 
the country. It is one of the larger medi- 
cal centers in the country and will 
become larger as soon as we receive 
funding necessary to do it in a reason- 
able way which will preserve quality of 
medical education. 

The North Hospital should be com- 
pleted some time late in 1972 with 
occupancy in January 1973. This will 
provide us with significant new clinical 
facilities, allow us to finally demolish 
the "old University Hospital" which has 
been used as an ambulatory facility for 
some years, and allow us to provide 
reasonable ambulatory services while 
expanding our bed services. It will also 
provide us with an Emergency Room, 
something that we have been without 
for the past several years, because 1 
do not consider what we operate in the 
basement of the University Hospital an 
Emergency Room. 

The Howard Hall addition, which is 
again extremely important for our ex- 
pansion, will be a 14-story addition to 
the current building. Planning is under 
way and working drawings are just 
about completed. State funds are in 
hand and we have been approved by all 
the Federal agencies for funding. How- 
ever, we are currently in a $600 million 
backlog for medical school, dental 
school, and schools of osteopathy con- 
struction. If the Congress' version of 
the medical school construction act 
goes through which will contain $225 
million for medical school construction, 
we stand a good chance of being 
funded. But if the President's budget is 
kept, there is only $90 million for medi- 



cal school construction and then our 
chances are not nearly so great. 

During the past year we have been 
engaged with the V.A. in such things as 
site selection, and such things as trying 
to arrive at a price for the site for the 
new hospital to be built on our campus. 
However, things are moving slowly be- 
cause V.A. funding has been tenuous 
in the past year. Fortunately for the 
school, about two months ago Sen. 
Mathias became interested in the need 
for the V.A. facility not only for improve- 
ment of health care for veterans in 
Maryland, but also because he is fully 
aware that it is absolutely critical that 
we get this facility if we are to in- 
crease class size to 200 students. He 
has been actively at work and 1 remam 
hopeful that in the near future this 
project will be kind of given the final 
shove and gain its own momentum and 
proceed. 

In the area of curriculum, we made 
a significant change two years ago 
when we went to an elective senior 
year and put into the curriculum a re- 
quired program and Ambulatory Care. 
This year the school has moved to 
adopt basically a pass-fail system for 
the medical school courses. 

This past year has not been a good 
year for our Family Practice program. 
This is the program that was begun in 
1960 through the efforts of Dr. Wood- 
ward in the Department of Medicine. 
At its formation the Division was in the 
Department of Medicine, did not have a 
defined budget, and was located in the 
ambulatory services building which was 
very crowded. In part the problems 
stem from the Division itself and there 
is no question that in part that they 
stem from the school. About a year 
and a half ago we defined the role of 
the Division more firmly so that it could 
have its own program and its own 

space. 

The space problem concerned sep- 
aration of the Evaluation Clinic where 
patients came in without appointments 
to be screened which several years 
ago had been combined with the Fam- 
ily Practice Clinic. It took over a year 
to get to the point where we were re- 
organized enough in that building to 
separate this function out, and that has 
now been done. There is a separate 
clinic for screening. The Family Prac- 



51 



tice Clinic and Family Practice area is 
now defined and is used only by Fam- 
ily Practice. Today the division has ties 
with both the Department of Medicine 
and the Department of Preventive Med- 
icine. Steps also have been completed 
to define the budget for the Family 
Practice Program which is more than 
adequate to allow that program to grow. 
The American Academy of Family Prac- 
tice sent a two-man survey team to the 
school to survey our program and make 
suggestions as to how we can further 
improve this program. That report is 
not yet to me and I will take it to the 
faculty for their consideration. This 
school has had a commitment to the 
program, it will continue to have a 
commitment to that program. The pro- 
gram will be allowed to grow along 
with other programs here on the cam- 
pus so that the students can have the 
opportunity they desire to participate 
in various types of clinical training pro- 
grams. 

I would like to publicly recognize the 
great contributions of Dr. William Lay- 
man, a family practitioner from Hagers- 
town. Dr. Layman took a sabbatical 
from his practice and came to Baltimore 
and almost single-handedly kept the 
Family Practice program functioning 
through this difficult period. The school 
and the specialty of Family Practice are 
very much in his debt. 

We have been making an effort to 
improve the ambulatory services and to 
make them more of a focus of teaching 
here on the campus. I don't know how 
far we can really go until the North 
Hospital is open. Last fall the Ambula- 
tory Facility was officially condemned 
by the City of Baltimore. A temporary 
one-story building is being constructed 
immediately behind the Ambulatory Fa- 
cility which will allow us to house Family 
Practice, Radiology services, and labo- 
ratory services. We should be able to 
make this transition in January. This 
will allow us to expand and to continue 
to reorganize as we prepare to move 
into the North Hospital. 

One final point is that the University 
itself is undergoing an administrative 
change. It was decided that we would 
move from a central president, who 
acted essentially as the Chancellor of 
the College Park Campus, to a decen- 



tralized campus system with each cam- 
pus having its own chancellor. Dr. Albin 
O. Kuhn who was the Chancellor of both 
the new Catonsville campus and this 
campus, has decided to move to this 
campus fulltime. As with any change in 
organization, this one has caused some 
difficulties but I continue to believe that 
the longterm benefit far outweighs the 
immediate difficulties we are having 
adjusting to this. This will be the first 
time in the history of this campus that 
we had someone speaking for us and 
for us alone and I can't help but believe 
that we will benefit from that voice. 

I enjoy very much this opportunity 
every year to bring you up to date on 
the school. I attempt to do it in as 
straightforward a way as possible so 
that you will know precisely what some 
of the assets of the school are, and 
there are many, and also some of the 
problems that we face. 

Thank you very much. 




s:\«f 




Mrs. F. W. O'Brien shows photographs of Davidge Hall to Dr. F. A. Reynolds '21. R. A. Young '46. J. H. 
Hombaker '30 and O. C. Mandry '21. 





Dr. S. V. Tompakov '40 with 1971 graduates, 
Mr. and Mrs. H. M. Tompakov, his son and daughter- 
in-law, and Mrs. Tompakov. 



Dr. G. H. Brouillet '35 and son, George, Jr. '71 
discuss graduation exercises. 




Dr. D. Hope '40 gives his daughter, Diane, final words 
of advice before her graduation from the School of 
Nursing. Her mother is a 1939 Maryland Nursing 
graduate. 




p. Rogers, senior class president, is congratulated 
by his wile, also a medical student, and his mother 
and lather. Dr. W. B. Rogers '43. 



mo^ 




Or. D. J. Myers '51. W. J. Benavent '46 ana 

Dr. A. Saavedra '51 chat before Alumni Day activities 

got under way. 



Dr Rachael K. Gundry '31, Dr. Elizabeth Acton '43, 
Dr. Ruth W. Baldwin '43 and Dr. Evangeline M. Poling 
'50 look at a plaque listing all past Gold Key 
recipients. 



55 




THE PURPO^^ 
OF THIS JOB IS 

. •« f Pv 




davidge hall 



Charles Hackett 

The State of Maryland, the City of 
Baltimore, the University, and you, have 
in your hands a symbol, and probably 
one of the most unique early nineteenth 
century buildings in the country. If not 
preserved It would be a tremendous loss 
to the history of this city. 

Historical association with significant 
historical movements, great men, or im- 
portant events is a basic reason for pre- 
serving historic buildings and sites. 
Early restorations evoked a feeling of 
nostalgia, a romantic and sentimental 
longing for the early days and old ways. 

Today we emphasize the total picture 
much more. Most of the early restora- 
tions were concerned mainly with the 
exterior of the building and little was 
done to recreate an authenic interior or 
appropriate setting. The whole preserva- 
tion movement is giving us new histori- 
cal perspective on our lives and prob- 
lems of today and furnishing us with 
historical inspiration. 

You have a marvelous opportunity 
here at Davidge Hall. Its Anatomical 
Theatre and Chemical Hall can present 
convincingly the very interesting early 
history of medical education in this 
country. It can offer history of actual 
experience. This kind of social history 
has a satisfying unity. Historic buildings 
properly presented and including au- 
thenic exterior settings and carefully fur- 
nished rooms cause hundreds of details 
to fall into place. 

Preservationists must seek living uses 
for landmarks — uses that are in keep- 



ing with the structures themselves and 
will not harm them. Your Davidge Hall 
can be much more than just a museum. 
It constitutes a living tradition, a highly 
visible link between the past and the 
ever-evolving present. Certainly your 
present and future teachers and stu- 
dents cannot help but be impressed and 
inspired to lecture and learn in class- 
rooms of such historical significance. 

For a proper restoration you will need 
an overall plan and a great diversity of 
skills, training, and talents. Architectural 
and historical research must be method- 
ical and exact. Drawings and specifica- 
tions must be prepared by experts ex- 
perienced in this relatively new field of 
preservation architecture. 

I recommend you require the services 
of an appropriately experienced his- 
torian, architect and curator — each of 
them liable to be temperamental and 
possessive, and together needing an 
overall director serving as coordinator, 
taskmaster, wet nurse and resident psy- 
chiatrist! 

When the time comes for the actual 
construction work, the builder — and 
his representative on the job — must 
have sympathy and understanding of 
the objective and the ultimate results. 
The workmen, down through the lowest 
echelon, must be instructed. 

I leave you with a piece of advise — 
try it. It's worth every penny. 

Editors Note: Speeches of other par- 
ticipants in Alumni Day will be pub- 
lished in a subsequent Bulletin due to 
the lack of space in this issue. 




)recomnnencennent and awards day 
une 4, 1971 



Precommencement and Awards cere- 
monies for the 1971 graduating class of 
the School of Medicine were held at 
10 a.m. in the Baltimore Civic Center. 

Following an academic procession, 
the convocation was given by the Rev. 
Carl H. Greenawald and Dr. John H. 
Moxley III, welcomed the graduates, 
their families and friends. Dean Moxley 
then presented the recognition awards 
to the following: 
Faculty Gold Medal 

Trenton K. Ruebush 11 
Certificates of Honor 
Summa Cum Laude 

Trenton K. Ruebush II 
Magna Cum Laude 

Alan L. Dubin 

Lawrence A. Fleming 

Brian M. Benson Jr. 

Robert A. Schuman 
Cum Laude 

Michael Y. Faulkner 

Gary A. Grosart 

Richard A. Bordow 

Walter H. Whitman Jr. 

Robert L. Brenner 

Donald M. Rocklin 

Peter W. Beall 

Elliotts. H. Bondi 

Charles F. Hobelmann Jr. 

Leslie B. Barnett 

Lucienne A. Cahen 

Daniel L. Cohen 
Awards were presented as follows: 
Balder Scholarship Award 
For highest degree of academic achieve- 
ment 

Daniel L. Cohen 
Dr. Wayne W. Babcock Award 
For excellence in Surgery 



Peter W. Beall 
Dr. Jacob E. Finesinger Prize 
For excellence in Psychiatry 

Robert J. Neborsky 
Dr. Leonard M. Hummel Memorial Award 
Gold Medal — Outstanding qualifications 
in Internal Medicine 

Walter Howard Whitman Jr. 
Dr. J. Edmund Bradley Pediatric Award 
For excellence in Pediatrics 

Daniel L. Cohen 
Dr. Milton S. Sacks Memorial Award 
For excellence in Hematology 

Michael Y. Faulkner 
Dr. William Alexander Hammond Award 
For excellency in Neurology 

Leslie B. Barnett 
Student Council Certificates 

Michael J. Maloney 

Paul T. Rogers 

Rena V. Kay 

Richard A. Bordow 

Peter M. Hartmann 
S.A.M.A. Golden Apple Award 
For interest in medical education and 
excellence in Teaching 
Clinical Years 

John D. Young, M.D., professor and 

head. Division of Urology 
Preclinical Years 

David B. Ludlum, M.D., professor 

Cell Biology and Pharmacology 
House Officer 

Mark Applefeld, M.D., Department of 

Medicine 
S.A.M.A. Service Awards 

Jerry Herbst 

Robert M. Shannon 
The hooding of graduates and the Hip- 
pocratic Oath concluded the cere- 
monies. 



57 




ALUMNI ASSOCIATION SECTION 



OFFICERS 

President 

Edward F. Cotter '35, M.D. 

Pretldenl-elect 

Henry H. Slartzman Jr. "50, M.D. 

Vice-presidents 

John H, Hornbaker '30, M.D. 
Benjamin M. Stein '35, M.D. 
William S. Womacl< "48, M.D. 

Secretary 

Robert B. Goldstein '54, M.D. 

Treasurer 

Arlie Mansberger '47, M.D. 

Executive Director 

William H. Triplett '11 BMC, M.D. 

Executive Administrator 

Francis W. O'Brien 

Executive Secretary 

Louise P. Girken 

Members of Board 

William J. R. Dunseath '59, M.D. 
William H. Mosberg Jr. '44, M.D. 
Charles E. Shaw '44, M.D. 
Joan Raskin '55, M.D. 
Donald T. Lewers '64, M.D. 
Cliff Ratliff '43, M.D. 
Joseph S. McLaughlin '56, M D. 
Arislides Alevizatos '60, M.D. 
John F. Strahan '49, M D. 

Ex-otficio Members of Board 

Wilfred H. Townshend Jr. '40, M.D. 
Theodore Kardash '42, M.D. 
John H. Moxley III, M.D. 



President's Letter 

Dear Fellow Alumni: 

I wish to pay tribute to Dr. Theodore Kardash and 
express the appreciation of the Alumni Association for 
his resourceful leadership and wise council as President 
of the Alumni Association. 

Reorganization of the "Bulletin" has been a major 
project this past year. A plan of organization has been 
developed and a newly appointed Editorial Board will 
approve and evolve a policy and format which will pro- 
vide an interesting and informative publication for the 
alumni and others interested in the University of Maryland 
School of Medicine. 

Plans to renovate and have Davidge Hall approved as 
a National Historic Shrine are proceeding. The Alumni 
are encouraged to contribute generously to this project 
which will be a major financial commitment. 

The majority of the graduates of our school have estab- 
lished themselves as private practitioners in the various 
disciplines of Medicine. The Alumni Association is eager 
to see that this way of providing health care shall have 
continuing success. Unfortunately, segments of our so- 
ciety in densely populated urban areas remain outside 
this health delivery system. Although we are all involved 
to some extent with this problem through our local and 
State Medical Societies, the Medical Schools are par- 
ticularly under great social and political pressure to be 
actively involved and supply leadership to solve the prob- 
lem of delivery of health care to this low income group. 

While we seek to have our school yield private prac- 
titioners of medicine to the community, we must recog- 
nize and support the endeavor of Dean John H. Moxley III 
and the faculty of the School of Medicine to rapidly ad- 
vance the biomedical research potential of our school. 

It is hoped that the "Bulletin" will be a medium of 
communication of different points of view as our school 
grows in prominence, providing practicing physicians, 
educators, scientists and scholars to the community and 
maintaining great concern for the problems and welfare 
of the community. 

Please submit your suggestions regarding new activities 
and interests pertaining to the future role of the Alumni 
Association. Any information about alumni is desired to 
help complete our records regarding their activities, in- 
terests in medicine and civic affairs and professional 
achievement. 

Sincerely, 



o 



u 



U^tX\ 



J 




Edward F. Cotter, M.D. 
President 



ilumni board action 



-rancis O'Brien 

During the past fiscal year, a number 
Df major problems confronted the Medi- 
:ai Alumni Association and were con- 
sidered for action by the Board of 
Directors. Among these were the fol- 
owing areas which required the atten- 
tion of the Board: 

Reorganization of The Bulletin, School 
Df Medicine. Selection of a fulltime 
Vlanaging Editor and consideration as 
10 what changes, if any, should be made 
in The Bulletin were of primary concern. 
^ new IVlanaging Editor was hired in 
January and proceeded to get out the 
January and April issues. The Board 
considered the first step in reorganiza- 
tion was to establish guidelines for the 
Editorial Board, the Chief Editor and the 
N^anaging Editor. These guidelines are 
being formulated and it is believed 
when crystallized will provide for a 
better publication from the School of 
Medicine and the Alumni Association. 
As you recall, your April issue arrived 
according to schedule as should future 
issues because of the reorganization 
and hiring of a fulltime Managing Editor. 
Problems in the reorganization still exist 
but close relations are maintained be- 
tween the Dean's Office and the Alumni 
to resolve these as soon as possible. 

Planning for Alumni Day 1971 was 
under discussion by the Board at each 
of its meetings. Early in the year an 
Alumni committee met with representa- 
tives of the Senior Class to obtain their 
views on how their classmates felt about 
attending the annual Alumni banquet. 
The representatives were of the opinion 
that the students would prefer that 
rather than attending the banquet that 
the Alumni donate a sum to their class 
fund for loans to future medical stu- 
dents. The Board feels that traditionally 
the graduating class is invited to the 
annual banquet and they offered to con- 
tinue this practice. However, the Board 
said it is willing to consider the stu- 
dents' proposal if it could be shown 
this was the feeling of the majority of 
the class. It was decided that this year 
the graduating class would be invited 
to the banquet and the reception for 



the 50 year graduates, thereby estab- 
lishing a new concept of honoring both 
classes. The Board approved loans to 
students in the amount of $1,000 and 
made a donation of $300 to the Student 
Microscope Fund. 

Reunion Class Captains were assisted 
in contacting their classmates through- 
out the year through several letters sent 
out from the Alumni Office. In the in- 
terest of making Alumni Day evening 
shorter, a feature speaker was not 
planned so that all those attending the 
banquet would have a longer oppor- 
tunity to be with their classmates and 
friends during that evening. 

Another concern of the Board was to 
obtain adequate space for your Alumni 
Office. At one time it was considered 
that the Alumni Office would occupy 
the entire second floor of Davidge Hall. 
By this means an Alumni Lounge would 
be provided for visiting physicians and 
their friends along with adequate 
office space. However, it became ap- 
parent early in the year that this plan 
could not be visualized for at least two 
more years. Your Alumni Office did 
expand slightly on the second floor of 
Davidge Hall, but still requires more 
space to fully carry out its mission — 
to assist the School of Medicine and 
its graduates in any way possible. The 
subject of office space was discussed 
several times by President Kardash and 
Dean Moxley and the Board of Directors 
went on record to emphasize the desir- 
ability of more adequate office facilities 
if the Davidge Hall Restoration project 
is to succeed. 

As you know, at the end of 1970, a 
brochure on the plan to restore Davidge 
Hall, was sent out to all graduates and 
other interested friends. Your Alumni 
Office has been receiving on almost a 
daily basis, donations for this worthy 
fund. 

At each Board meeting the financial 
report of the Association was received 
and approved by the members of the 
Board. The Association has a fairly good 
financial standing. 

Respectfully yours, 




/i^ 0'&. 



Francis W. O'Brien 
Executive Administrator 



59 



alumni gold key award 



Rolling up his sleeves and plowing 
in . . . that's how Dr. William Houston 
Toulson, professor Emeritus of Urology, 
remembers his part in the growth of 
the School of Medicine. 

A native of Chestertown. Md., he is 
the recipient of the Alumni Honor Award 
and Gold Key for 1971. 

Despite his lack of direct contact 
with the University today, the 1913 
School of Medicine graduate is still very 
interested in his school, the students 
and changes being made in the field 
of medicine. 

"I have very little contact with the 
school. I'm an Emeritus Professor and 
when I got out, I got out completely. 
There's nothing worse for a department 
than to have an old fellow around giv- 
ing you new ideas that date back to the 
Civil War period," he says smiling. "Dr. 
Young (head of the Department of Uro- 
logic Surgery) is a very fine chap, a 
very personable fellow and very effi- 
cient with patients. I've given talks oc- 
casionally, but I'm up in my eighties, 
and I just haven't got the gumption to 
grind out papers like I use to do." 

Dr. Toulson graduated from Chester- 
town High School and received his 
A.B. and master's degree with science 
honors from Washington College in 
1908 and 1911, respectively. 

"When I started work shortly after 
I graduated and when I was down at 
the clinics, I knew the students by their 
first name, where they were from and 
something about them. Towards the last 
I couldn't remember and it would em- 
barrass me when I would go to medical 
conventions and some students would 
come up to me and say, 'Don't you 
recognize me? You taught me in 1947' 
or something like that. After you teach 
100 of them every year for 34 years 
... it just got pretty well out of control," 
says the doctor, who retired as pro- 
fessor and head of Maryland's Urology 
Department in 1955. 

What does he remember as the most 
dramatic change that occurred during 
his days at Maryland? 

"I think the most dramatic was that 
during my student days and shortly 
after, the University of Maryland, then 




known as a proprietary school, under- 
went major changes in its growth to 
become part of a university." 

"As a proprietary school it was 
owned by members of the faculty. Dr. 
Reichlove, Dr. 
Shipley, Dr. Gar- 
ner and Dr. Low, 
a lot of names 
that are in the 
old books, really 
owned the med- 
ical school. 
They never real- 
ly made any 
money out of it, 
but they thought 
it was their duty to keep the old place 
going. In 1910 the Rockefeller Founda- 
tion gave money to a commission to be 
headed by Dr. Simon Flexner of New 
York to make a nationwide survey of 
medical schools." 

"At that time, there were nine medi- 
cal schools in Baltimore City and they 
were almost diploma mills. You could 
register there and go on and work at 
nights as a streetcar conductor. In due 
time, you got your degree. The Flexner 
Committee came to examine this school 
and they found we were deficient in 
things like basic sciences and we didn't 
have enough hospital beds for the num- 
ber of students being taught. We didn't 
have enough faculty, especially in basic 
science and above all, we had no 
University connection. Our monetary 
budget was terribly low for a medical 
school of our size. 

"So in 1913, the University of Mary- 
land, Medical School, merged with the 
old Baltimore Medical College. In 1915 
they merged with the old College of 
Physicians and Surgeons on Saratoga 
and Calvert streets. About 1920, they 
merged with the old Maryland Line 
Agricultural College at College Park 
forming a university, at least a nucleus 
of it. Then the Law School came in, 
Pharmacy, Dentistry, Nursing and like." 

"It was about 1920 when the Univer- 
sity of Maryland really got off to a 
university status and then they started 
getting a little bit of money from the 
state. Year by year it has grown so that 



ie University of Maryland, Medical 
chool, now is accepted by everyone 
f the accrediting agencies and it ranks 
mong the finest schools in the 
ountry." 

"So, I've watched all this during my 
fetime and am proud to be a part of 
. Of course, I felt as though I was roll- 
ig up my sleeve and plowing into the 
'hole business, but I hope I contrib- 
ted a little something anyhow." 

And, indeed Dr. Toulson has con- 
ibuted greatly to his school through 
is student and teaching years. 

Dr. and Mrs. Toulson, who live at 
403 Falls Road Terrace, have three 
hildren: Mrs. J. Edward Johnston of 
altimore; Mrs. Kennon Jayne, New 
;anaan, Conn, and William Houston 
oulson, Jr. of Washington, D.C. and 
1 grandchildren. 

The author of numerous monographs 
alating to urology and surgery, he is 

member of the Baltimore City Medical 
■ociety, the Medical and Chirurgical 
acuity (president in 1949), the Ameri- 
an Urological Association (president 
lid-Atlantic section in 1950), the Ameri- 
an Association Genito Urinary Sur- 
eons, Societe Internationale D'Uro- 
jgie and the American College of 
lurgeons. 

His military record includes two years 
1 France in World War I as a captain 



in the Medical Corps U.S.A. The first 
year with the British Expeditionary 
Forces and the second with Evacuation 
Hospital No. 8, American Expeditionary 
Forces. During World War II he was 
consultant to the Selective Service and 
Veterans Bureau. 



Gold Key Awards have been given 
to the following doctors: 

1948 — W. Wayne Babcock '93 P & S 

1949 — Nolan D. C. Lewis '14 

1950 — Arnold J. Tuttle '06 

1951 — George E. Bennett '09 

1952 — Louis A. Buie '15 

1953 — Emil Novak '04 
1954— Fred W. Rankin '09 

1955 — George W. Rice '16 

1956 — Joseph Nataro '25 

1957 — Charles Reid Edwards '13 

1958 — Norman T. Kirk '10 

1959 — Edgar B. Friedenwald '03 

1960 — Stanley E. Bradley '38 

1961 —Walter D. Wise '06 

1962 — Arturo Raymond Casilli '14 

1963 — Louis A. M. Krause '17 

1964 — Hugh R. Spencer '10 

1965 — Theodore McCann Davis '14 

1966 — T. Nelson Carey '27 

1967 — Eva F. Dodge '25 

1968 — Thomas B. Turner '25 
1969 — Frank Mason Sones '43 

1970 — Abraham Harry Finkelstein '27 



ilumni activities 

HE 20's AND 30's 

DR. LEWIS M. OVERTON '29, asso- 
iate professor in the Department of 
)rthopaedics. University of New Mexico, 
as received a grant to study chronic 
'Steomyelitis (bone infection) from the 
ipjohn Company. Dr. Overton was chief 
'f the Orthopaedic Surgery Department 
if Lovelace Clinic from 1947 until he 
Dined the medical school faculty at the 
Jniversity of New Mexico in 1968. 

DR. HERBERT BERGER '32, Staten 
sland. New York, has been elected 
hairman of the section on medicine of 
ne New York Academy of Medicine. 

DR. MYRON L. KENLER '33, Miami, 
■la., was licensed to practice in Florida 
1 1969 and is employed fulltime on the 
taff of the University of Miami Student 
iealth Service, Coral Gables, Fla. 

DR. LOUIS J. KOLODNER '36, assist- 



ant professor of surgery, Johns Hopkins 
University School of Medicine, delivered 
a paper at the Royal Thai Army Hospital 
in Bangkok, Thailand, during his world 
tour in October and November last year. 
The paper was entitled "Some Studies 
and Experience in Biliary Tract Sur- 
gery." 

THE 40's 

DR. R. M. N. CROSBY '43 and ROB- 
ERT LISTON have received the All 
America Features Award for an article 
"Dyslexia: What you can and can't do 
about it" which appeared in Grade 
Teacher, a publication with a large cir- 
culation among elementary school 
teachers. The award is presented by 
the Educational Press Association for 
excellence in scientific writing in an 
educational journal. Dr. Crosby has also 
been appointed to the National Advisory 
Committee on Handicapped Children 



61 



by the Secretary of Health, Education 
and Welfare Richardson. The committee 
will administer the new laws on the edu- 
cationally handicapped. 

DR. ROBERT E. WISE '43, of Boston, 
has been re-elected to another three- 
year term on the Board of Chancellors 
of the American College of Radiology. 
He is chairman of the Department of 
Diagnostic Radiology at Lahey Clinic, 
Boston. Dr. Wise has served as chair- 
man of the ACR Commission on Public 
Relations for three years and will con- 
tinue in this capacity until 1974. The 
ACR is a medical association repre- 
senting physicians who specialize in the 
use of X-rays and other radioactive 
substances for diagnostic and thera- 
peutic purposes. 

THE 50's 

DR. MORTON D. KRAMER '55, Balti- 
more, Md., has been appointed chief, 
Sections of Neurology and Electroen- 
cephalography and director of the 
Electroencephalography Laboratory in 
the Department of Medicine, St. Agnes 
Hospital, Baltimore. 



THE 60's 

DR. LAURENCE R. GALLAGER '62, 
Columbia City, Md., has been appointed 
associate director of Medical Education 
at St. Agnes Hospital, Baltimore. In his 
new capacity he is responsible for 
planning, developing and organizing 
methods of recruiting medical gradu- 
ates for the hospital's intern and medi- 
cal education program. 

DR. GERSHON J. SPECTOR '64, 2255 
Lenox Rd., Atlanta, Ga., will join the 
Washington University School of Medi- 
cine, Department of Otolaryngology, in 
St. Louis, Mo. effective August 1, 1971. 
He will be an assistant professor of 
Otolaryngology. 

DR. EARL S. SHOPE '65, has recently 
moved to Alumbank, Pa. where he is 
working in hematology, clinical path- 
ology and general medicine. He is asso- 
ciated with a clinic, Medical Associates, 
and a hospital, Wimber Hospital, in 
Alumbank. Prior to his move he was 
associated with the Armed Forces In- 
stitute of Pathology, Hematology 
Branch, Washington, D.C. 



alumni on other faculties 



Medical schools list the following 
University of Maryland, School of Medi- 
cine, alumni on their 1970-71 faculty: 

The 20's 

Oscar Costa Mandry '21 

University of Puerto Rico 
Isadore E. Gerber '26 

Mt. Sinai School of Medicine 

The 30's 

Abraham M. Kleinman '30 

Mt. Sinai School of Medicine 
Victor Montilla '30 

University of Puerto Rico 
Henry I. Berman '31 

University of Louisville 
Robert F. Rohm '31 

University of Pittsburgh 
Alexander Allan Krieger '32 

University of Pittsburgh 
Kermit E. Osserman '33 

Mt. Sinai School of Medicine 
Max Needleman '34 

Mt. Sinai School of Medicine 
Landon Timberlake '34 

University of Alabama 
Milton H. Adelman '35 

Mt. Sinai School of Medicine 
Maurice Nataro '37 

University of Louisville 



Ephraim Roseman '37 

University of Louisville 
Juan A. Rossello '38 

University of Puerto Rico 
Donald J. Silberman '38 

University of Alabama 
Aaron Stein '38 

Mt. Sinai School of Medicine 
David Kairys '39 

Mt. Sinai School of Medicine 
Joseph Edwin Schenthal '39 

Tulane Medical Center 

The 40's 

Luis R. Guzman Lopez '40 

University of Puerto Rico 
Gulliermo Pico '40 

University of Puerto Rico 
William R. Piatt '40 

Washington University, St. Louis 
Carl Eliot Rothschild '40 

Mt. Sinai School of Medicine 
Joseph W. Sloan '40 

Mt. Sinai School of Medicine 



William I. Wolff '40 

Mt. Sinai School of Medicine 
Carlos M. Chiques '41 

University of Puerto Rico 
Joshua M. Perman '41 

Mt. Sinai School of Medicine 
Robert A. Moses '42 

Washington University, St. Louis 
Otto C. Phillips '42 

University of Pittsburgh 
Ramon I. Almodovar '43 

University of Puerto Rico 
Sherman S. Brinton '43 

University of Utah 
Aaron N. Finegold '43 

University of Pittsburgh 
Jose M. Tor-i-es Gomez '43 

University of Puerto Rico 
Luis M. Isales '43 

University of Puerto Rico 
Francisco R. Raffucci '43 

University of Puerto Rico 
Enrique Perez Santiago '43 

University of Puerto Rico 



Dharma L. Vargas '43 

University of Puerto Rico 
Ernesto Colon Yordan '43 

University of Puerto Rico 
Eugene Hayward Conner '45 

University of Louisville 
J. Howard Latimer '46 

University of Utah 
Walter M. Wolfe '46 

University of Louisville 
Pascal D. Spino '47 

University of Pittsburgh 
George Winokur '47 

Washington University, St. Louis 
Joseph Aponte '48 

University of Puerto Rico 
Robert Chamovitz '48 

University of Pittsburgh 
Guy Donald Niswander '48 

Dartmouth Medical School 
William G. Thuss, Jr. '48 

University of Alabama 
Edward W. Stevenson '49 

University of Alabama 

The 50's 

Frederick Shepherd '50 

University of Louisville 
Law Lamar Ager '51 

University of Alabama 



Ricardo Mendez Bryan '51 

University of Puerto Rico 
David M. Kipnis '51 

Washington University, St. Louis 
Mario R. Garcia Palmierl '51 

University of Puerto Rico 
Joseph John Noya '54 

Tulane Medical Center 
Henry B. Higman '55 

University of Pittsburgh 
Charles Benton Pratt, III '55 

University of Tennessee 
C. Clark Welling '55 

University of Utah 
Jerald H. Bennion '56 

University of Utah 
Paul V. Slater '56 

University of Utah 
Wilfred F. Holdefer, Jr. '57 

University of Alabama 
Francisco E. Oliveras '57 

University of Puerto Rico 
Lynn B. Robinson '57 

University of Utah 
Richard R. Flynn '58 

University of Utah 
Richard H. Keller '58 

University of Utah 
Gilbert Isaacs '59 

University of Pittsburgh 



The 60's 

Franklin Ross Hayden '60 

Tulane Medical Center 
William E. Latimer '60 

University of Utah 
Morton Smith '60 

Washington University, St. Louis 
Andres Acosta '61 

University of Puerto Rico 
Joseph C. Battaile '61 

University of Tennessee 
Carlos Girod '61 

University of Puerto Rico 
David B. Paul '62 

University of Pittsburgh 
Verne Peterson '62 

University of Utah 
Hernan Padilla '63 

University of Puerto Rico 

Brian L. Rasmussen '63 
University of Utah 

Gustavo Alberto Colon '64 
Tulane Medical Center 

Sigmund L. Sattenspiel '65 
Mt. Sinai School of Medicine 

Dana H. Clark '66 
University of Utah 

W. Bryan Staufer '68 
University of Pittsburgh 



missing alumni 



The following alumni are listed as 
missing by the Alumni Office since no 
address or record of death is on file. 
Alumni having any information about 
the following graduates should notify 
Col. Francis O'Brien, Medical Alumni 
Association, 201 Davidge Hall, Balti- 
more, Md. 21201 
John Wirt Graham, M.D. '26 
Hiilard V. Staten, M.D. '27 
Thomas P. Thompson, M.D. '27 
Louis J. Levinson, M.D. '28 
Paul F. Gersten, M.D. '30 
T. H. Tomlinson, Jr., M.D. '32 
Frank R. Stephenson, M.D. '32 
Matthew M. Cox, M.D. '42 
Maurice I. Shub, M.D. '42 
H. Bellinger Stafford, M.D. '43 
Daniel Bair Lemen, M.D. '45 
Joseph Weintraub, M.D. '45 
Michael J. Coffey, M.D. '47 
James E. Anthony, Jr., M.D. '47 
Jay Lewis Bisguyer, M.D. '50 
Michael C. J. Sulka, M.D. '50 
Martin Wm. Treiber, M.D. '53 
Jules B. Ediow, M.D. '53 
WilliamR. Cohen, M.D. '56 



Samuel J. Mangus, M.D. '56 
Harry J. Fitch, M.D. '58 
David A. Perras, M.D. '59 
William E. Latimer, M.D. '60 
William R. Fleming, Jr., M.D. '61 
Mayer M. Katz, M.D. '62 
Alfred S. C. Ling, M.D. '62 
Richard J. Belinic, M.D. '63 
Harry A. Spalt, M.D. '63 
Mona B. S. Belinic, M.D. '64 
John H. Axley, Jr., M.D. '65 
Jeffrey L. Brown, M.D. '65 
Robert N. Whitlock, M.D. '65 
Richard S. Glass, M.D. '66 
Augustin K. Gombart, M.D. '66 
Thomas M. Hill, M.D. '66 
James W. Spence, M.D. '66 
Elizabeth A. Abel, M.D. '67 
Larry B. Feldman, M.D. '67 
George A. Lapes, M.D. '67 
Howard R. Rosen, M.D. '67 
Donald E. Novicki, M.D. '67 
Robert Brull, M.D. '68 
Michael J. Deegan, M.D. '68 
Charles C. Edwards, M.D. '68 
Frank A. Franklin, Jr., M.D. '68 
William N. Goldstein, M.D. '68 
Charles J. Lancelotta, M.D. '68 
Steven F. Manekin, M.D. '68 



63 



necrology 



Samuel Watson Page, '02 P & S, 

Greenwood, S.C., died February 10, 

1971. 
James G. Blower, 05 P & S, Akron, 

Ohio, has died. 
Anthony W. Lamy, '08 P & S, Elizabeth, 

N.J., died February 1971. 
Simon Wickline Hill, '09, Regent, N.D., 

died June 2, 1970. 
J. D. Dinsmore, '09 P & S, Nova Scotia, 

Canada, has died. 
Glen G. Haight, '10 BMC, Audubon, 

Minn., died March 27, 1971. 
Manuel R. Janer, '12 P & S, New York, 

N.Y., has died. 
Jesus Maria Buch, '13, Baltimore, Md., 

has died. 
Arthur Casilli, '14, Elizabeth, N.J., 

died March 10, 1971 
Manuel E. Pujadaz-Diaz, '14 P & S, 

Santurce, Puerto Rico, died January 

5, 1971. 



John Edward Davis, '19, Welch, W. Va., 
died April 19, 1970. 

THE 20's AND 30's 

Rhea Richardson, '20, Macon, Ga., died 

April 4, 1971. 
George R. Joyner, '21, Suffolk, Va., has 

died. 
Walter B. Parks, '24, Gastonia, N.C., 

has died. 
Alexander A. Doerner, '35, Pacific 

Palisades, Calif., died May 16, 1970. 

THE 40's 

William Herbert Morrison, '41, 

Baltimore, Md., died February 13, 

1971. 
Granville Hampton Richards, Jr., '43, 

Port Deposit, Md., died March 7, 1971. 
John B. Davis, '45, Frostburg, Md., 

died October 11, 1970. 
John L. Rosenthal, '45, Norfolk, Va., 

has died. 



BuLLetin 



university of maryland scliool of medicine 

Articles do not necessarily reflect the views of the School of 
Medicine, the Editorial Board or the Medical Alumni Association. 



Policy — The Bulletin of the School of Medicine 
University of f^aryiand contains scientific articles of 
general clinical interest, original scientific research in 
medical or related fields, reviews, editorials, and 
book reviews. A special section is devoted to news 
of Alumni of the School of Medicine, University of 
Maryland. 

Manuscripts — All manuscripts for publications, news 
items, books and monographs for review, and corre- 
spondence relating to editorial policy should be 
addressed to Dr. John A. Wagner, Editor, Bulletin of 
the School of Medicine, University of fi/laryland, 31 
S. Greene Street, Baltimore 1, Md. Manuscripts should 
be typewritten double spaced and accompanied by a 
bibliography conforming to the style established by 
the American Medical Association Cumulative Index 
Medicus. For example, the reference to an article 
should appear in the following order: author, title, 
name of journal, volume number, pages included, and 
date. Reference to books should appear as follows: 
author, title, edition, pages, publisher, and date pub- 
lished. A reasonable number of illustrations will be 
furnished free. 

Reprints — At the time the galley proof is returned 
to the author, the publisher will insert an order form 



for reprints which are purchased directly from the 
publisher. Any delay in the return of this order form 
may result in considerable additional expense in 
obtaining reprints. 

Alumni Association News — The Bulletin publishes 
as a separate section, Items concerning the IJniversity 
of Maryland Alumni and their Association. Members 
and friends are urged to contribute news items which 
should be sent to Dr. John A. Wagner, Editor, Bulletin 
of the School of Medicine, University of Maryland, 
31 S. Greene Street, Baltimore, Md. 21201. 

Subscriptions — The Bulletin is issued 4 times a 
year. Its subscription price per annum, post paid is 
$3.00; single copies, $.75, when available. Active 
members of the Medical Alumni Association receive 
the Bulletin in connection with the payment of annual 
membership dues. Non-Alumni subscriptions should 
be made payable to the University of Maryland and 
remitted through the office of Miss Jan K. Walker, 
Managing Editor. 

Advertising — The Bulletin accepts a limited number 
of advertisements. Rates may be obtained upon appli- 
cation to Miss Jan K. Walker, Managing Editor, Dav- 
idge Hall, School of Medicine, 522 W. Lombard St., 
Baltimore, Md. 21201. 



Photo credits: A. Aubrey Bodine, p. 12, 13, 14; 
Scott Schumaker and Philip Szczepanski. 
Design: Bruce Laine 



garamond/pridemah 

BALTIMORE 




fit' "aGti^ 




TAYLOR MANOR HOSPITAL 

For Psychiatric Diagnosis and Treatment 



IRVING J. TAYUOR. M.D. 
MEDICAL DIRECTOR 



ELLICOTT CITY, MD. 
PHONE: HO 5-3322 



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The 

John D. Lucas Printing Co. 

26th & SissoN Streets 

Baltimore, Maryland 21211 

Phones: BElmont 5-8600-01-02 



University of IVIaryland 
School of Medicine 
522 W. Lombard St. 
Baltimore, Md. 21201 



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wmm^ 




John A. Wagner, B.S., M.D 
'^ chief edi*"' 

Jan K. Wall 
managing editor 

editorial b 

George Entwisle, T' 

Robert B. Goldstein, 

Donald T. Lewers, M"._ 

Arlie Mansberger, M.D. 

Frederick J. Ramsay, Ph.D. 

Edwin H. Stewart Jr., M.D. 

Wilfred H. Townshend, r ' 

W. Douglas Weir, I 

Edward F. Cotter, I 
John H. Moxley III, I 
Francis W. O'Br 

(ex-gffjcio) 




Left — Ceiling of 
Anatomical Hall gives the illusion of 
being coffered by the decorative 
plasterwork which has rosettes of 
of anthemion, circles, semicircles and 
filler lozenges. Right — Ehler's wood- 
cut of Davidge Hall as it appeared 
in 1873. 



BU[l£tin 




PUBLISHED FOUR TIMES A YEAR, JANUARY, APRIL, 
JULY AND OCTOBER JOINTLY BY THE FACULTY OF 
THE SCHOOL OF MEDICINE OF THE UNIVERSITY OF 
MARYLAND AND THE MEDICAL ALUMNI ASSOCIATION. 



shock trauma center 

six minutes later 

shock trauma nursing 

medical student's view 

no better place to learn 

air-evac helicopters help save lives 

today's neglected disease — trauma 



Francis Rackeman 2 

Judy Bobb, R.N. 7 

Clayton Raab 12 

Sonia Hughes 14 

Lt. Frank Hudson 16 

R. Adams Cowley, M.D. 18 



potpourri 




26 


admissions and curriculum 






I changing medical education 


Robert Shannon, M.D. 


29 


' curriculum changes 


Frederick J. Ramsay, Ph.D. 


32 


admissions 


Karl H. Weaver 


34 


academic medical center 


John H. Moxley III, M.D. 


37 


professors of surgery 1807-1970 


Harry C. Hull, M.D. 


44 


alumni activities 




53 


necrology 




60 



Second class mailing privilege authorized at Baltimore, Maryland 





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The radio call was urgent. A motorist 
was trapped in a wrecked automobile on 
busy U.S. Route 40 near White Marsh. 

Miles from the accident scene on a 
routine patrol was a Maryland State Po- 
lice helicopter. Responding to the State 
Police dispatcher's call for help, the heli- 
copter landed within minutes only 150 
feet from the wreck on the highway 
which had been blocked to traffic by 
ground police. 

The motorist, whom firemen had to ex- 
tricate from the car which had hit a tele- 
graph pole, was in deep shock. 
' The helicopter pilot and his observer- 
: medic partner went to work. One 
jconverted the four-passenger helicopter 
linto a flying ambulance and the other 
prepared the victim for removal from the 
scene by placing her on the aircraft's 
respirator. 

Six minutes later the helicopter with 
its unconscious patient landed atop the 
multi-story parking garage adjacent to 
the University of Maryland Hospital. 
Waiting at the heliport were an ambu- 
lance and a medical team from the Uni- 
versity's unique Center for the Study of 
Trauma. 

As the ambulance sped down the ramp 
and towards the University Hospital's 
Emergency Room entrance, a doctor and 
a nurse from the shock treatment center 
were already administering aid and mak- 
ing preliminary evaluations which would 
help in making critical decisions about 
the patient's care. 

At the ambulance entrance a bold red 
line painted on the floor guided the arriv- 
ing team and victim to the special red 
brick building attached to the main hos- 
pital and up to the fourth floor recovery 
area which is the heart of the center. 

The large room contains a raised is- 
land nursing station overlooking a dozen 
surrounding cubicles each equipped with 
modern breathing, suction, monitoring 
and other lifesaving devices. Three doc- 
tors, two nurses and a technician who 
were already checking other critically-ill 
patients in the unit gathered around the 
new admission. 

Lifting the woman carefully onto a 
special bed, one doctor connected an au- 
tomatic breathing machine to the wom- 
an's windpipe. Another inserted a long 



plastic tube in an artery to measure 
blood pressure, while a third person in- 
serted a tube in a vein with its tip reach- 
ing the heart. Samples of blood and 
urine were taken for analysis in the labo- 
ratories operated around-the-clock for 
just such care. 

Watching the teamwork was Dr. R. 
Adams Cowley, director of the nation's 
first fully-equipped shock trauma center. 

"Violence is on the increase and get- 
ting worse. Injuries are becoming more 
serious and there's no end in sight," 
said Cowley adding: "With severe multi- 
ple injuries, you live or die depending on 
how rapidly you are picked up and trans- 
ported to a facility where there are ade- 
quate personnel and equipment to care 
for you immediately on arrival." 




Editor's Note; Francis Rackemann is a staff writer for the Baltimore Evening Sun and has written several 
articles about the shock trauma unit at Maryland. 



A buzzing noise sounded and a nurse 
went quickly to a patient whose lifesaving 
machine needed adjustment. 

"Our first job," said the director, "is 
to keep the severely injured and critically 
ill alive. Then comes diagnosis and treat- 
ment." 

Trauma is the medical term for injury 
caused by blows, cuts, blasts, suffoca- 
tion, shock, poisons and burns. In severe 
cases, shock is accompanied by a sharp 
drop in blood pressure which leaves a 
victim pale and white or blue if the lungs 
are affected. Lack of sufficient oxygen in 
the bloodstream often leads to a break- 
down of kidney, liver, lungs, brain, heart 
or other vital organ functions. 

University Hospital's Center for the 
Study of Trauma is a four-story, red 
brick building attached to the main hos- 
pital which was designed by Cowley and 
his colleagues. 

Equipment in the $2.5 million building 
ranges from a huge hyperbaric chamber 
in the basement for administering pure 
oxygen under pressure to patients with 
gangrene to equipment that automatically 
records respiration, blood pressure, 
pulse, temperature and the amount of 




oxygen consumed by the body among 
other physiological functions. 

Research labs are on the third floor 
and the fourth is devoted to the shock- 
trauma recovering unit where critically ill 
emergency cases are treated. The build- 
ing is so designed that at least three 
more floors can be added. 

The center which is manned 24 hours 
per day has on its staff 71 doctors, 
nurses, laboratory and other technicians 
and researchers. Members of the staff 
often skip lunch and remain on duty be- 
yond their regular hours just to keep 
their patients alive. 

Miss Elizabeth Scanlan, an associate 
director of the nursing for the main hos- 
pital, is head of the center's nursing 
staff. She helped organize the center's 
program. 

Of Miss Scanlan, one physician com- 
mented: "She has developed a staff of 
nurses who are devoted to the kind of 
care not often seen. Our nurses work 
hard and we cannot compensate them 
very well, but you can see the satisfac- 
tion of a job well done against over- 
whelming odds." 





The center staff gives high praise to 
the Baltimore Fire Department ambulance 
service and to the Maryland State Police 
helicopter crews for their "fast, efficient 
and cooperative services." 

Most of the more than 400 patients 
admitted to the unit during the past year 
were brought by ambulance, but Dr. Paul 
Hanashiro said that without the helicop- 
ter service "85 per cent of the 140 pa- 
tients brought to us would have been 
dead in a general hospital environment." 

Maryland State Police acquired its first 
helicopter in 1960. It was traded in 
1968 for a Bel JetRanger. A second heli- 
copter was purchased in January 1970 
and a third went into operation in June 
1971. The helicopters costing $100,000 
each average 130 hours a month of 
flying time. 

The unmarked aircraft are used also 
for tracking criminals and lost people, 
solving traffic jams, photographic mis- 



sions, spotting lost boats, oil slicks, sto- 
len vehicles, rescuing people, searching 
for underwater objects, bodies, making 
engineering studies and transporting 
emergency blood and organs as well as 
patients. 

Patients remain at the shock-trauma 
center anywhere from three days to as 
long as three weeks. A man with lockjaw 
must be kept paralyzed with drugs to 
keep him for convulsing until his tetanus 
problem disappears. 

Treatment with pure oxygen under 
pressure in the center's basement hyper- 
baric chamber saved a man's arm from 
amputation after gangrene set in stem- 
ming from a broken thumb. 

Only the most severely injured or criti- 
cally ill are admitted to the shock trauma 
center for treatment. 

"Many of these patients would not be 
alive today if we didn't have this pro- 
gram," concluded Cowley. 



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shock trauma 
nursing 



Judy Bobb, R.N 




Judy Bobb, dressed in a pink surgical 
gown, carefully reconstructed the actions 
of a shock trauma nurse during a shift in 
the intensive care unit when her thoughts 
were interrupted by a familiar sound . . . 

That's one thing. You become ex- 
tremely aware of any helicopter that is in 
the air. I've heard every helicopter that's 
flown over the unit since I came last Oc- 
tober. I always wonder if he is bringing a 
patient; if he isn't, why isn't he? 

It's fascinating. You learn to identify 
your own choppers and when you see 
them in the air, if it's the right color, the 
right kind and he's heading for the city, 
you figure he's been up to something, or 
he's going to get involved in something. 

Sometimes we hear them from the unit 
and you can just imagine in your own 
mind what is going on. When you have to 
meet a helicopter at the helipad, that's 
exciting. It's the kind of thing that you'd 
like to have film footage of that you 
could show all your family — you crawling 
under the chopper. It often seems dra- 
matic, but our actions are vital to the life 
of the victim. 




Editor's Note: Miss Bobb received a bachelor of science in nursing from the University of Colorado. 
Before coming to University Hospital in October 1970 she worked in intensive care units at several 
Denver. Colo, hospitals. 



For a brief moment the young nurse's 
speech quickened and became full of an- 
ticipation, but after the helicopter could 
no longer be heard she returned to her 
recitation. 

As much experience as I have had in 
coronary care — two years in a very quiet, 
small intensive care unit — I was use to 
shock trauma and all the equipment. But 
here, the unit as a whole is overwhelm- 
ing. You walk in and you don't know 
what to look at first; yet you're looking at 
everything and you see all of these peo- 
ple hanging in traction with lines all over 
their bodies and people scurrying about. 

Admission is one of the hardest things 
about working in the unit because you 
have to satisfy everyone at the same time 
and still do the things you have to do. 
Most of the time you work on a one-to- 
one basis. One nurse is usually responsi- 
ble for a single patient; whether you have 
more than one patient depends on the 
load. Sometimes it gets so busy that 
even two of you can't handle the load at 
one time. 

After working in the unit a while you 
can tell when it's about time for an ad- 
mission. It's a very nebulous feeling and 
it's not something that you can define by 
any means. But, you can almost predict 
what type of admission will be made. For 
instance, admissions for the hyperbaric 
chamber come in spurts and after a cer- 
tain period of time everyone starts look- 
ing for another. Usually within the week 
we get one. It is very odd. 





Sometimes when you go to work you 
just know that you aren't going to get 
anybody new — it's not the right weather, 
or the right kind of any number of things 
that you can't define . . . it's a sixth 
sense. Or, you know that the chopper is 
going to be flying that night and that 
he's going to bring somebody in. If one 
person gets the feeling, then everybody 
starts watching for an admission. One 
nurse in particular is good at predicting 
an arrival. If she says there is going to 
be a patient, we'll have an admission 
within 24 hours, you can guarantee it. If 
she says it's going to happen it will. 
She's never been wrong since I've known 
her. 

Usually a resident, a nurse or a corps- 
man meet the incoming helicopter and 
take with them a box of emergency drugs 
and an oxygen tank. You meet the pa- 
tient, make a fairly brief evaluation and 
then transport them to the ambulance. 
The ambulance then drives the victim, 
the resident and the nurse to the emer- 
gency room and from there the group 
goes up to the unit. 

We've had as little as five minutes no- 
tice from the helicopter that they are 
coming. One unit is set up all the time. 
All the lines are there, everything that 
you need to admit the patient and take 
care of him, except his medicines and all 
of his intravenous (I.V.) solutions. If you 
suspect that another patient is coming, a 
second unit is readied so that you're one 
ahead. You always have to stay one jump 
ahead because it takes from five to ten 
minutes to get a unit ready. Working by 
yourself it could take as long as 20 min- 
utes. 




The patient is immediately transferred 
from the stretcher to a bed, and then 
comes a rapid period of evaluation where 
a lot of decisions are made in a very 
short period of time. After the initial 
crises you start doing the definitive 
things like giving blood, deciding if they 
need x-rays, surgery, cast or traction. 

For example, we had one case with a 
stab wound in his chest. He was up in 
surgery within 40 minutes and within 
that time we cannulated him; but a ven- 
ous line in; put an arterial line in; got all 
his blood samples; checked his blood 
maybe eight or ten times; hooked him up 
to the monitor; put another chest tube 
in; put a Foley catheter in; typed and 
crossed him for seven units of blood; 
gave him about four units and sent him 
up to surgery, with a couple of phone 
calls off and on. And, it took me, two 
corpsmen and a medical student to get 
all this done. When you get an admission 
everybody congregates in the same place 
and you end up with one unified action. 
Everyone is doing what is absolutely nec- 
essary to stabilize the patient immedi- 
ately. 

If during the evening you get a critical 
admission, you must juggle all of the pa- 
tient assignments. If the new patient is 
fairly stable, then often this reassign- 
ment isn't necessary. Most admissions 
take a minimum of an hour out of your 
time, you can't leave the bedside. This 
often takes the remaining time left after 
your regular responsibilities. If you must 
be with a critical patient continually, an- 
other person will watch your patients 
along with their own. 



During the first couple of hours you 
stay pretty close to the patient and every- 
one is monitored. The parameters of 
the monitor can be set at very close lim- 
its so that even a slight change will alert 
you. When the alarm goes off somebody 
checks. After you have worked there a 
while you can tell individual patients — 
the alarm is all the same sound — but 
you can tell whether it's an alarm that 
you have to run for because something 
bad has happened or whether somebody 
has just rolled over, scratched in the 
wrong place, pulled the lead off or whose 
temperature has gone up. 

If the patient is very critical and ex- 
tremely unstable you will probably spend 
the rest of the night there until relieved 
by the next shift. If the patient should 
have a cardiac arrest, again the whole 
team comes through. 

The first time someone arrested on me 
there must have been four nurses and a 
doctor there; the minute the patient was 
stable everybody disappeared. There was 
blood all over the room, the patient 
needed to be turned, the bed needed to 
be made, and I had medicines to get, but 
everybody was gone. I can remember 
standing there saying, "Where did you all 
go? Come on, I'm not done yet, I need 
some more help." I didn't really, but the 
feelings of desertion were there and it 
was a strange experience. 

Most of the rest of the time you can 
lose yourself by going off into a corner 
where you see no one except for the resi- 
dent who is taking care of that patient 
for the evening. If you get a critical pa- 
tient and there is an emergency, people 
emerge from all corners and focus on the 
one patient. The minute the emergency is 
over, they'll disappear again. 

Each person adjusts to the unit at 
their own rate. It takes about six months 
before you can function without close su- 
pervision. You don't know everything, but 
you know where to find almost everything 
and you know how to find out about 
things. This is because of the extraordi- 
nary relationship that exists with the res- 
idents. 

The typical nurse-doctor relationship is 
that the doctor is your boss, so to speak. 
You take his orders and you question 
them only when you are within your nurs- 
ing rights to question them. But basi- 
cally, you don't have very much to say 
about what goes on. 




In shock ttjumj you i\ie much more 
on an equal level. When you get new res- 
idents in who aren't familiar with the 
routines of what needs to be done, you 
end up being their teacher. This is an 
odd relationship for most nurses to be in 
— the role of being responsible for 
seeing that the resident does it right. 
The decisions are still his to make and 
his is the medical aspect of it. Some 
times you do question what he is doing 
and you are expected to be. not just one 
jump ahead of him. but at least on an 
even keel with him — to ktiow some 
things that you do and some things that 
you don't do. You end up with a much 
greater responsibility for knowing what is 
going on with your patient. It's an odd 
relationship. 

With attending men. generally you go 
to them with a question instead of giving 
them answers. However, after residents 
on the shock trauma unit have been 
around awhile you end up more on an 
equal par basis. He calls on you for in- 
formation that he needs, and you do the 
same with him. 

Medical students are generally unob- 
trusive since they are there to observe. 
However, on occasion you get involved in 
some of the conferences on patients. If 
you have the time you can sit down or go 
around with them as they look at the pa- 
tient, look at the patient's lab work and 
-evaluate all the things that have hap- 
pened. I have learned more about what 
x-rays should look like since I have been 
there than ever before in my nursing ex- 
perience. 




You begin to pick up trends because 
the things you don't see frequently in 
other nursing services you get frequently 
because of the type of patient admitted 
in shock trauma. You begin to classify a 
certain group of symptoms and when a 
new patient comes into the unit you 
watch the course he's taking then decide 
among yourselves how long he is going 
to be in the unit, whether he's going to 
survive nicely, whether it's going to be a 
stormy course . . . things of this nature. 

Another thing nurses get involved with 
is what they call intensive care psy- 
chosis. Some patients just don't react fa- 
vorably to being confined in a unit where 
they don't get much sleep; somebody is 
always disturbing them for medications; 
they are full of holes where they have 
been stuck with needles: they put in a 
trachea for breathing and they can't talk 
and they sedate the patient. The patient 
loses all sense of time and place. 

We also see people who withdraw be- 
cause they cannot stand all of the noise 
and pressure, plus their own fears, their 
own worries ... so they withdraw into 
themselves and then you don't know why 
they are doing that either. It is really a 
hard thing to care for. 

Some patients leave the unit and their 
recovery is fantastic. It's as if immedi- 
ately after they go out the door, they 
start getting better. With a new stimula- 
tion, a new environment and people to 
talk to, new sounds, new colors, new 
lights and shadows . . . One girl just re- 
cently was in a fairly deep coma and the 
minute she left us she started talking 




again, started recognizing people and 
laughing. It was fantastic because she 
wasn't doing any of this when she was 
with us. 

When we come on duty we are briefed 
on what has happened on the unit pre- 
viously and then are assigned patients. 
Tests and other routine are usually es- 
tablished on an hourly basis. There are 
three categories of patients and they re- 
ceive care accordingly. You just go 
around in a circle and finish one circuit 
then it's tinfie to start another. Usually 
you have about ten minutes out of every 
hour to do a few of the nice things. The 
time varies tremendously with the patient 
load. 

One of the major differences between 
medicine and nursing is in the approach 
to the patient. Nurses tend to get in- 
volved and they don't see patients as 
cases or diseases quite as much as doc- 
tors do. Very often, especially on grand 
rounds, the chief of the service and the 
residents talk about the patient, but they 
never talk to him. This is upsetting to me 
as a nurse because that person is a per- 
son. I may not like him, he may be a dif- 
ficult patient, but he is a person never- 
theless. How would you feel is somebody 
was talking about you, they don't ask 
you anything and they don't tell you 
anything. When they come around and 
you're asleep, they start poking and 
pricking you full of holes, testing your re- 
flexes and taking off the dressings ... I 



resent this for the patient's sake. How- 
ever this is fairly typical of a teaching in- 
stitution. It has always bothered me and 
I guess it always will. 

Sometimes the strain gets bad . . . 
you see people die or just get worse . . . 
people that you don't really know but like 
as persons. There are times when you 
might lose four or five patients in a short 
period and you get very depressed. You 
wonder what the heck you are doing; who 
does everybody think they are, and you 
think you are not doing anything for any- 
body. 

There are people you can accept will 
die because you can just look at their in- 
juries and know they don't have much of 
a chance. Then there are some patients, 
who you think in the beginning were 
going to die, look like they are going to 
make it and you think maybe you could 
save this one . . . then something hap- 
pens, it really hurts. You feel a personal 
loss and I think everyone feels a little 
sense of defeat. You know them as nice 
people . . . that's a nursing nice. 

A nursing nice means people that 
smile, people who don't pull out of re- 
straints and people that don't demand a 
lot of your time. It's somebody who 
doesn't get in your way, somebody who 
lets you do what you want to do and 
when you want to do it, according to 
your schedule, doesn't interfere and 
doesn't ask for anything special. 

It's nursing with a uniqueness that 
can't be duplicated. 




11 



b 



medical 

student's 

view 





Clayton Raab 



It's enough to scare you to death . . . 

Clayton Raab, a sophomore medical 
student, had some intensive care expo- 
sure while a nursing assistant on the pe- 
diatrics intensive care unit during his 
freshman year, but he found quite a dif- 
ferent situation when he had a summer 
position in the shock trauma unit. 

Working in the pediatrics intensive 
care unit 1 was around many crises, but 
we only had maybe one intravenous (I.V.) 
line and a respirator. In shock trauma 
there are lines for I.V. and central ven- 
ous pressure as well as arterial lines . . . 
it was just enough to scare me to death. 
There are tubes all over and you are ex- 
pected to move around the patient and 
help change his bed. 

The first day I felt very insecure espe- 
cially with all the tubes. I was afraid that 
I would pull one out unintentionally. I 
was given a tour and then my training 
iDegan. Now I'm working in the unit 
seven nights a week. 




A special type of care is involved on 
the unit as well as having to work around 
a lot of complicated machines. The nurs- 
ing procedures I learned on the pedia- 
trics ward allowed me to concentrate on 
details and probably made it easier for 
me to learn faster than other medical 
students who don't have experience. 
Even after only a month, I was able to 
take a patient on my own. You aren't al- 
lowed to give medications but you can 
run I.V. fluids. Working the 11 p.m. to 7 
a.m. shift is quieter than during the day 
and the nurses have taken an interest in 
helping me learn what is to be learned. 
My transition into the unit wasn't as bad 
as I originally thought it might be. 

Your relationship with the nurses is 
unique. It depends upon how critically ill 
the patient assigned to you is and what 
is happening elsewhere in the unit. When 
times get very busy you are given a little 
more responsibility than originally be- 
cause there is nobody else. I guess that 
is actually a way of growing in responsi- 
bility. You can't learn anything unless 
you've actually done it. You'll never learn 
about running fluids by being told and 
working under a nurse's supervision you 
actually can learn how to do things your- 
self. 

Many of the patients come into the 
unit with trauma, but they are further 
traumatized by having people fill them 
full of needles . . . even the intensive 
care they are given creates problems. It's 
a matter of so much care constantly. You 
can't sleep because you are being turned 
or given medications and the lights are 
on. We turn them down at night so it 
helps the patient get some rest. Some of 
the patients aren't as critical as others 
but need supervision, so they are in the 
unit. 



Ed/tor's Note: The father of two, Clayton Raab is beg/nn/ng his sophomore year in medical school. He 
received his B.S. in zoology from the University of Maryland, College Park. 




Families of patients are discouraged 
from coming in the unit. To see all these 
tubes and wires, all the machines going 
. . . it just more or less intensifies the 
parent's anxiety. For instance, if a doctor 
told you that your son was fine after 
open heart surgery and you saw him with 
an intertracheal tube in his throat and 
wires all over him, you would think he 
was just about dead. It's a good idea to 
keep people out. 

It is possible to get involved, but you 
can't allow yourself to become too in- 
volved with a patient. I have two children 
and have seen kids on the pediatrics in- 
tensive care unit die. I was surprised 
that it didn't upset me . . . it's rather a 
strange sensation. I thought I'd really 
feel something emotionally for these peo- 
ple and especially the kids, but you really 
don't. Can you really afford to? 




Working in the unit also has made me 
sensitive to accidents. You wouldn't 
catch me on a motorcycle because of 
what I have seen on the ward. There are 
a number of automobile accident victims 
on the unit too. But we also have other 
patients like those who have had open 
heart surgery. You would picture the unit 
full of badly injured people, but often 
times there are those who just need in- 
tensive nursing care or they can't find 
room for them in another unit. 

When word of an admission is received 
the cubicle is made ready and the team 
goes to meet the helicopter. It's an eerie 
feeling, early in the morning when it's 
twilight and you see the little light on the 
helicopter coming in out of the sky. Every- 
body is in their pink gowns and it all 
seems like something out of a science fic- 
tion movie. In terms of an emergency, 
things are handled quite calmly and 
efficiently. 

This experience has vastly increased 
my appreciation of nurses. Because of my 
experiences in both units I have shaped 
some strong opinions about the type of 
nurses that I would like to have looking 
after my patients when I'm a physician. 

Working every night as I do I have a 
chance to quiz the nurses about things 
as they rotate through the ward. During 
vacation nurses from other services work 
on the unit and I have learned many dif- 
ferent aspects of nursing from them. You 
can appreciate the lack of knowledge and 
the amount of knowledge that some 
nurses do or don't have. And, you can 
see just how serious it could be unless 
you know what should be done and what 
is considered good care for the patient. 
The nurses are given a great amount of 
responsibility by physicians and know a 
fantastic amount of medicine. They cer- 
tainly have taught me a lot. 

It's a fascinating place to work and 
learn. 



13 



no better place to learn 



Sonia Hughes 

During my junior year I was working in 
a pediatric care study witli a little boy 
who had transposition of the great ves- 
sels — his aorta and pulmonary artery 
were switched when he was born. He re- 
quired a palliative repair and later had 
open heart surgery which I watched. After- 
wards I visited him in the shock trauma 
unit. 

Noting the care given patients in the 
unit, Sonia Hughes decided that perhaps 
this type of training would enhance her 
nursing experience. She is the first nurs- 
ing student to work in the unit. 

This is a valuable learning experience. 
Everyday I learn something new. How- 
ever, everyday I become a little more 
frustrated at what I don't know, but peo- 
ple don't condemn you for your lack of 
knowledge. You can ask seemingly the 
dumbest questions and someone will take 
time to explain even if they must repeat 
themselves five times. And, there are ex- 
tensive procedure manuals which explain 
what is to be done. 

Certain procedures done in other parts 
of the hospital are done in the unit regu- 
larly and there is more opportunity to fol- 
low the status of a patient. Working in 
the emergency room you see the patient 
briefly and he goes to another floor. In 
the unit you deal with the patient on an 
emergency basis, he may go to surgery, 
but then he returns to the unit for care. 

A very unique aspect of shock trauma 
nursing is learning to know the expecta- 
tions and limitations of the equipment 
used. They teach you how to autoclave 
and clean the machinery as well as ex- 
plain how it should function properly. 
You must know the workings of the 
equipment and be able to spot something 
faulty which may be critical to the pa- 
tient. Before a respirator is used it is al- 
ways checked by the nurse. It's impor- 
tant because a respirator can kill a 
patient if not used correctly. 

One day an admission was made while 
I was there. Two medical students and I 
stood there and watched. I thought: I'll 
never be able to do anything, especially 
"that quickly. But it takes time, and I'm 
able to do more each day. 




Many of the people are young and in 
some ways I relate to them. It affects 
you no matter what age you are when a 
young child or person is injured or ill be- 
cause he has not yet lived a full life. This 
is because of the value society places on 
youth. An older person, you may think 
probably has lived a good life, but you 
ask: 'Why did this happen to a child?' 
You also might think: 'I've been in that 
circumstance and it could have been me.' 

For example, there are two patients 
lying in cubicles next to each other — one 
is a child and the other an adult. You 
feel for them both and you want to give 
them both good care. However, you see 
the child lying there attached to a respi- 
rator, he's in critical condition and his 
prognosis is questionable ... it tears 
you up a little more. 

Often times you think a patient is re- 
covering and when you return to duty a 
few days later he has died. This hap- 
pened to a patient I had. He was taken 
off the respirator and when I came back 
he was going back on it; he died the next 
day and I never expected that so soon. 

Driving and riding in a car makes me 
aware more than ever to be cautious. I 
often convey my sensitivity to others by 
describing what I see in the unit. You 
really respect an automobile after seeing 
so many accident victims — people who 
aren't even dangerous drivers. It's the 
other fellow you must look out for. An 
automobile is a dangerous weapon, more 
so than I ever thought before. 



Editor's Note: Miss Hughes is a senior nursing student. Her father, Dr. Lloyd Hughes, is an anesthesi- 
o/og/st in Prince George County. 



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Working service time on a service floor 

' was frustrating because I wanted to be- 
come more involved with my patients and 
there wasn't time. I hardly knew their 

: names. I was just doing a little bit here 
and a little bit there. I felt like I was 
spread so thin that I wasn't doing any- 
thing effectively. Working in the shock 
trauma unit is entirely different. There's 
the one-to-one relationship with your pa- 
tient. 

Working on the unit requires a desire 
to learn, because there is no way that 
you are not. In order to give good care 
you have to keep up, you have to be 
aware of what's going on with your pa- 
tient. It's not something that you can do 
from 9-5 p.m. A knowledgeable nurse or 
a good nurse is aware of her patient's 

' needs. She is not only aware of facts, 
but how they relate to him and she has a 
working knowledge of equipment as well 
as working physiology — how the patient 
feels, what is going to influence his re- 
covery or his stay in the unit. She has to 

, be thorough. 

A nurse should always question and 
know why something is done for her pa- 

>tient. There is more rapport in the shock 
trauma unit then in any other unit. It's 
much more of a teaching situation and 
they are much more willing to teach you. 

"They know that I'm a nursing student 
and they know that I don't have much 

. knowledge of the subject. Most of the 
personnel have worked there for quite a 
while and have had quite a bit of experi- 
ence. One day I asked a doctor what was 

-wrong with a child who had open heart 
surgery. I wanted to know what the con- 
genital defect was. He drew me a pic- 

'ture, diagrammed and explained the situ- 
ation to mie. 




-^iT^ 




Because I am the first nursing student 
to work in the unit, many of my class- 
mates question me about what happens 
there. They are curious who is being 
brought in by the helicopter. However, 
many of them comment that they wouldn't 
work in the unit. 

Before beginning work in the unit I 
had certain apprehensions. After accept- 
ing the job, I thought perhaps I had 
taken a wrong step. I had done some 
procedures, but if you've done something 
a couple of times you concentrate on the 
procedure and not the patient and his re- 
action. I didn't have much experience. 

I also thought that the nurses were su- 
perior and that they would not want to 
be bothered by a student. I was pleas- 
antly surprised. They are good about 
teaching, they understand that I don't 
know much, and they are willing to teach 
and help me learn. They're great! I'm 
really glad I did it and I can't see why 
anyone would not want to come and work 
in the unit. Because, as far as nursing 
care, there's no better place to learn. 



15 



air-evac helicopters help save lives 



Lt. Frank Hudson 
R. A. Cowley, M.D. 

"Since some accidents will always oc- 
cur, steps must be taken to minimize 
human losses resulting from them. . . ." 

Over the years, we have watched per- 
sons with life threatening injuries or Ill- 
ness die at the scene awaiting an ambu- 
lance, die on their way to the nearest 
hospital or die in that hospital due to in- 
adequate facilities, personnel and equip- 
ment to offer the necessary immediate 
treatment and care for survival. 

A study in which the deputy state 
medical examiner participated indicates 
that roughly 40 per cent of the persons 
killed in Maryland die in hospitals . . . 
and half of these could likely have been 
saved if promptly and properly diagnosed 
and treated. One concerned researcher's 
comment sums up the problem: 

It is essential that we strive for a rea- 
sonable balance between the need for 
prompt treatment and the better treat- 
ment which may be possible if the in- 
jured are taken to trauma centers. 

Still, present policy seems to be to 
transport most injured, without regard 
for the severity of their injuries, to hospi- 
tals whose chief distinction is being near- 
est the scene. When or if the receiving 
doctor feels the injury is too severe to be 
treated in his facility, the patient is 
transported to another hospital (provided 
he has survived thus far). This adds up 
to an appalling waste of time, which can 
be ill-afforded by the person with the life 
threatening injury or illness. 

To help overcome this problem, the 
University of Maryland Hospital devel- 
oped the Center for the Study of Trauma 
thus providing critical patients the best 
immediate treatment available in the 
country. Treatment centers of this caliber 
are enormously expensive and difficult to 
staff. As a result one cannot expect rapid 
development of additional facilities of 
this type; therefore, it is imperative that 
safe, rapid transportation be provided 
persons with life threatening illness or 
injury so the services of the center are 
made available to them. 




Medical authorities tell us that we 
should strive to have the severely injured 
in a well-equipped and staffed medical 
facility soon after they have been injured 
if complications from their injuries are to 
be reduced and their lives saved. Indica- 
tions are that 30 minutes from the injury 
to definitive medical treatment is usually 
acceptable with one hour being the out- 
side practical limit. With the surface traf- 
fic congestion of today and insufficient 
medical facilities equipped to handle the 
severely injured, the lightweight high- 
speed helicopter is the most effective and 
economical way to avoid congestion, 
cover the distances involved and assure 
that highway injured receive needed 
treatment in time. 

The State Police are duty bound to as- 
sure that the lives and safety of all per- 
sons in the state are safe-guarded and 
when injured or ill come under their 
care, they receive the best handling pos- 
sible under existing conditions. Their hel- 
icopters provide for transport of critical 
persons as an extension of normal police 
helicopter operations. This provides a 
sound fiscal base as existing know-how, 
facilities, equipment and personnel are 
utilized to the maximum. 



Editor's Note: Lt. Frank D. Hudson is chief of the aviation section in the Maryland State Police. 




The troopers assigned to the helicop- 
ters have completed the Red Cross ad- 
vanced first aid course, receive advanced 
ambulance attendant training from the 
Fire Service Extension, University of 
Maryland, and receive an intensive week 
of training in the Shock Trauma Unit. 

Our cooperative program, one of the 
few successful programs of this type in 
the country, has been a simple matter of 
developing community resources between 
the university. State Police and the city 
Fire Department Ambulance Service. 

State Police records show that 58,672 
persons were injured in Maryland from 
automobile accidents last year. Of the 
787 killed in these accidents, many could 
have been saved by fast, efficient heli- 
copter service to University Hospital's 
Shock Trauma Center. 

When persons are injured in an auto- 
mobile accident, volunteer fire company 
ambulance crews sometimes decide in- 
correctly to take the most serious to the 
nearest hospital, even though a helicop- 
ter is available. 

Such a case happened earlier this year 
when the helicopter landed near the 
scene of an accident. The ambulance 
crew decided to take the most serious 
case to the nearest hospital. When the 
State Police helicopter crew delivered the 
less severely injured victim to University 
Hospital, the county hospital where the 
other victim was taken called for the heli- 
copter because they did not have the 
necessary life-saving equipment. But it 
was too late. 

With a top speed of 150 miles per 
hour, helicopters can fly from the Mary- 
land-Pennsylvania line to University Hos- 
pital in less than 15 minutes and less 
than an hour from the Eastern Shore. An 
ambulance, even with wide-open siren, 
would require at least twice as much 
time because of traffic congestion espe- 



cially on weekends when most accidents 
occur. An emergency in Cumberland 
would take only an hour to reach Univer- 
sity Hospital by helicopter. 

Better service can be provided. The 
most obvious area that needs strengthen- 
ing is the education of and acceptance 
by police, ambulance and medical author- 
ities to the fact that the best interest of 
the patient must be served. Some units 
are still guarding what they believe are 
their prerogatives, thus causing some 
critical patients to be taken to an outly- 
ing hospital (and often held there) in- 
stead of going directly to a major trauma 
unit. Accreditation and categorization of 
hospital emergency departments could go 
a long way toward solving this problem. 
This approach has long been advocated 
by the National Research Council's com- 
mittee on trauma and shock. 

While we learn to better utilize equip- 
ment, personnel and systems, more 
high-quality emergency facilities with 
trauma units will be needed. Quick re- 
sponse helicopter service will also be 
needed statewide. Tentative studies indi- 
cate that as few as seven fully-manned 
helicopters are needed for definitive 
statewide service. 

Why not police helicopters in ambu- 
lance service? They complement not 
threaten surface units. The safety of the 
few victims demanding helicopter trans- 
port is compromised when handled rou- 
tinely. The police helicopter has been 
here for years, their crews are vastly ex- 
perienced in applying helicopter support 
to civil public service operations. Re- 
quired communications also have been 
here for years, the police communica- 
tions net is one of the finest designated 
for rapid emergency communications. 
This is an excellent opportunity for the 
public to realize a greater return for their 
investment in government. 



17 



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today's neglected disease-traur 



R. Adams Cowley, M.D. 
Benjamin F. Trump. M.D. 




Trauma, a killer of 115,000 persons 
annually roams American society virtually 
unchecked, picking its victims democrati- 
cally; without regard to age, race, color, 
or economic status; and except for the 
havoc left behind, very little is known 
about it. The name comes from the Latin 
or Greek for wound or injury. 

While trauma has been with us always, 
its effect is one of the least recognized 
and explored problems facing the physi- 
cian today. Because of the increased 
tempo of living, it is rapidly changing 
from endemic to epidemic proportions 
and the National Research Council now 
calls it "the neglected disease of modern 
society." 

Every fourth person will have some 
type of accident this year. Every eighth 
hospital bed will be occupied by an acci- 
dent victim. The most pathetic factor is 
that between the ages of 1 and 37 years, 
accidents are first in the cause of death, 
between the ages of 1 and 48 it is sec- 
ond, and if one looks at the overall pic- 
ture for all ages, it is fourth. In 1970 the 
National Safety Council estimates that 
over 49 million Americans were injured 
in all types of accidents. They also esti- 
mate injuries cost the nation $25 billion 
due to loss of wages, time at work, medi- 
cal and property expenses. 




THE PROBLEM 

Severely traumatized individuals are 
constantly present in large general hospi- 
tals, particularly those associated with 
medical schools such as ours. While we 
do our best to treat these people, many 
deteriorate and die. Unlike most patients, 
who are hospitalized for acute or chronic 
disease and for whom some type of defi- 
nitive therapy and care is planned, the 
accident or emergency ill victim becomes 
on admission an unwelcome patient since 
the hospital family is neither prepared 
nor geared to handle his emergency. He 
is most likely to be seen by the least ex- 
perienced house staff physician, the in- 
tern, during a period when time is of the 
essence and ripe clinical judgment is es- 
sential for his survival. Perhaps even 
worse, he is taken from the scene of the 
accident to the nearest hospital emer- 
gency room where there may not be a 
physician on duty and one must be 
called. 

Today, shock and trauma therapy is 
often self-defeating for a number of rea- 
sons. Good care seems less than aggres- 
sive because young physicians who staff 
emergency rooms are ill prepared to 
make even the first decisions that may 
be life-saving. Decisions are often com- 
pounded by a compromise with inade- 
quate treatment facilities, by harassment 
and pressure on a busy Saturday night 
with the intern, alone "on call," and by 
the impossibility of consultation because 
the senior staff member is busy in the 
operation room or treating another emer- 
gency on another floor, perhaps busy in 
another hospital. 



Editor's Note: R. Adams Cowley is professor of thoracic and cardiovascular surgery, chairman of the 
Division of Trauma, and program director. Center for the Study of Trauma. He received his M.D. from 
the University of Maryland. He is on the National Research Council committee on hyperbaric oxygena- 
tion and shock, member of all major surgery and and thoracic surgery societies and author of over 
200 articles pertaining to shock-trauma and thoracic-cardiovascular problems. Benjamin F. Trump re- 
ceived his M.D. from the University of Kansas School of Medicine. He is a member of many professional 
societies including the International Academy of Pathology and is the author of numerous articles and 
abstracts in the field. 



19 




This present dilemma of emergency 
care can be expected because most med- 
ical schools have done little to teach 
trauma beyond minimal first aid and 
have structured trauma education at the 
house staff level. Trauma and shock, as 
areas of special interest, have attracted 
few supporters. 

The hospital attitude toward this prob- 
lem is one of apathy in failing to provide 
the ancillary support so essential for 
proper care of the severely ill. In most 
hospitals, the emergency room has be- 
come the overburdened community out- 
patient clinic on nights, weekends, and 
holidays making good trauma care an im- 
possibility. Chemistry and blood gas lab- 
oratories so essential for critical care are 
seldom available at night and on week- 
ends when the incidence of accidental 
injury is greatest. Unavailability of proper 
x-rays, inadequate blood bank service, 
and the skeletal staffing of physicians 
and nurses on holidays, nights and week- 
ends, further handicap the experienced 
as well as the inexperienced physician. 

These factors and many others perpet- 
uate the same inadequate teaching, train- 
ing and therapy experience year after 
year. It is little wonder, then, that young 
physicians who are so well trained in 
most other aspects of medicine are 
poorly equipped to make proper deci- 
sions for resuscitation and emergency 
care. In the event of disaster or war, 
their inexperience in this area could have 
a calamitous effect. 







The public attitude toward trauma is 
one of indifference because in the experi- 
ence of the layman the physical injuries 
that are seen are usually sudden, muti- 
lating, distasteful, gruesome and indica- 
tive of unlikely survival. As a result, to 
the layman perfunctory treatment is ac- 
ceptable! Many people are thus allowed 
to die by general consent since the phy- 
sician, the hospital and the public have 
not accepted their responsibilities in 
trying to improve this desperate situa- 
tion. 

The total treatment of injured people 
on the basis of existing information is 
also inadequate in most situations. Ther- 
apy continues to fall into a pattern of 
guesswork because the physician is una- 
ble to study the trauma patient who fails 
to respond to treatment. Scientific study 
and observation, along with good care, 
are synonymous with good therapy and 
the right of every patient. Inability to col- 
lect scientific information on what is tak- 
ing place under conditions of therapy can 
only result in mediocre patient care. If 
scientific observations are not made dur- 
ing this period, the experience is lost and 
the physician is really not accepting his 
responsibility to the patient for he cannot 
otherwise guide therapy in the direction 
of decreasing mortality and morbidity 
due to accidental injury. 




Awareness at the University of Mary- 
land of these problems has resulted in 
the establishment of a Center for the 
Study of Trauma, an emergency and 
acute care facility designed to combine 
the highest development of patient care 
and teaching with research facilities that 
permit investigation in support of therapy 
for the emergency critically ill. 

Since 1956 the program has devel- 
oped in six major stages: 

1. Initially, the project was limited to 
the animal experimental laboratory. As 
the studies progressed, two important 
factors became evident: a) Although ani- 
mal experimental work was necessary for 
many baseline and model studies, vari- 
ance in response of different species in- 
dicated the necessity to study injury in 
man more directly; b) In order to under- 
stand the overall structural pathophysiol- 
ogy and biochemical alterations occurring 
in the organism, it was necessary to 
expand the program to include multidis- 
ciplinary support in order to effectively 
explore phenomena occurring at the cel- 
lular level. 

2. On January 1, 1961 an Army pilot 
Clinical Shock Trauma Unit program en- 
abled a clinical shock-trauma team to de- 
velop and make primary investigations 
into the mechanism and treatment of 

' shock and trauma victims. A two bed 
C.S.T.U. for emergency care and resusci- 
tation was established and systematized 
collection of pertinent data on trauma 
and shock patients on a 24-hour basis 
was made for the first time anywhere. 
Experimental data on animals was used 
for support of observations in humans. A 
large amount of previously unavailable 
clinical, physiological and biochemical 
data on patients in various types and 
stages of shock and trauma were col- 
lected and analyzed which was invaluable 

' in developing treatment and care re- 
gimes. 




3. A cooperative, rapid transportation 

system with the Maryland State Police 
utilizing helicopters for emergency evacu- 
ation of the critically ill was established 
with the completion of our FAA approved 
all-weather heliport which has been func- 
tional since June 1, 1970. A communica- 
tion system has also been developed to 
monitor the helicopter in flight, the 
Shock Trauma Recovery Unit and the 
Baltimore City Fire Department ambu- 
lance service. The latter transports the 
patients from the heliport to the center. 
This has resulted in the development of 
an interhospital transferral system for 
the severe multiple trauma patient whose 
problems overwhelm the resources of the 
small community hospital. As a result, 
we have become the accident receiving 
center for the State of Maryland and sur- 
rounding areas for patients who demand 
immediate multidiscipline resuscitation 
and care. Thus, every severely injured 
citizen in the state is within one hour of 
the center. So far, 261 patients have 
been brought to the center by this mod- 
ality. 

4. By 1963, the development of a 
background in shock and trauma enabled 
us to obtain a $800,000 National Insti- 
tute of Health Research Facility Grant for 
a Center for the Study of Trauma. A 
matching sum of $1.2 million for con- 
struction of the center was successfully 
negotiated with the State Legislature. 
This center was completed in June, 1969 
creating a complete self-contained inte- 
grated treatment and study unit for se- 
verely injured patients. 



21 




5. By our acquisition and installation 
of an IBM 1620 computer to assist in 
patient care, we have implemented a low 
cost, on-line automated system for ac- 
quisition and management of physiologi- 
cal data from patients in the Shock 
Trauma Recovery Unit. This system frees 
the nursing staff from much of the time- 
consuming record keeping v^^hich is nec- 
essary for both patient care and re- 
search. We have also developed a data 
storage and retrieval system, utilizing 
disk files on the IBM 1620 computer. 
This aides the investigators in selecting 
and organizing patient data collected 
from 1962 to the present. The informa- 
tion is used to perform data analysis and 
to test hypotheses concerning the phe- 
nomena involved in shock and trauma. 
The ultimate goal is to use this modality 
for total automated patient care and is 
under continuous development. 

6. The trauma program has long been 
aware that before therapy can advance 
further, more knowledge must be ob- 
tained at the cellular level which means 
that there must be a study of not only 
the cell but also of its components. We 
have been remarkably fortunate in ob- 
taining the interest and support of Dr. 
Benjamin F. Trump, our new chairman of 
the Department of Pathology, who plans 
to develop the Department of Pathology 
with cell injury as the principle focus of 
study. 




CLINICAL PROGRAM 

Our new 12-bed facility, the Shock 
Trauma Recovery Unit, has completed its 
first full year of operation. Since its 
opening, we have demonstrated that we 
could increase our functional capacity 
from a two-bed unit to a multi-bed facil- 
ity without altering our competence to 
handle critically III patients. This simulta- 
neously provides a training and educa- 
tional programs for personnel at all lev- 
els — the medical student, the house 
officer, the nurse, and the visiting staff — 
and finally, research continues in order 
to update our current understanding and 
management of the critically-ill patient. 




Although our patient load increased, 
our overall mortality decreased from 34 
per cent to 22 per cent. During the first 
five months of 1971, we have further in- 
creased our patient load and average 40 
patients a month with a 20 per cent mor- 
tality rate. Admission to the center is re- 
stricted to patients with severe multiple 
injuries, head trauma, overwhelming sep- 
ticemia, refractory shock, gas gangrene 
infections, scuba diving accidents or life 
threatening trauma. Most of these pa- 
tients die in the general hospital setting. 
In patients with head injuries alone, we 
have decreased the mortality rate over 
1968 from 79 per cent to 22 per cent. 

We are, therefore, meeting our pro- 
gram goals to: 

— Extend knowledge on the severely 
injured. 

— Standardize resuscitation measures 
by: a) making results more predicta- 
ble since knowledgeable people are 
not always available to give treat- 
ment, b) formulate rules for the 
care of the emergency ill by taking 
the newly acquired knowledge and 
restructuring it for use by other 
groups working in hospitals that 
have less advanced facilities and 
personnel, c) demonstrate the ad- 
vantages and usefulness of a spe- 
cialized facility in the care of the 
emergency critically ill. 

— Clinical testing of therapy under 
standard conditions. 



RESEARCH 

Under the best of circumstances where- 
in we are providing rapid transportation 
from the scene of the accident, rapid di- 
agnosis and treatment and expert multi- 
disciplinary care in a facility built for this 
purpose, many of our patients still die. 
Why? To some day answer this question, 
the central theme of the research pro- 
gram is to understand the pathophysiol- 
ogy of shock and trauma in the human, 
with the hope of thereby improving pa- 
tient care. Generally, the treatment of 
trauma in man has been directed to the 
local injury, its cause and correction. 
Treatment has seldom been aimed at the 
total problem involved; namely, the reac- 
tion of body to trauma and the mainte- 
nance of life and repair of injury. We 
have found that in addition to local dam- 
age, the systematic injury resulting from 
the breakdown of normal protective bar- 
riers leads to liver, pulmonary and renal 
complications. Thus infection, hemor- 
rhage and other lesions of stress super- 
venes and the local lesion has now be- 
come a phenomena of general deteriora- 
tion and death. 



23 



To improve the treatment of the criti- 
cally injured, the search to understand 
the cause and effect of shock resulting 
from trauma which leads to deterioration 
of so many body processes has consti- 
tuted the basis for our study of injury; 
namely, inadequate perfusion induced by 
injury produces two major effects at the 
organ and cellular level. Subnormal sup- 
plies of oxygen and cellular nutrients 
caused profound changes in organ and 
cellular metabolism, incompatible with 
normal function; and failure to remove 
certain metabolic products produced by 
these changes in metabolism at an ade- 
quate rate induce further deterioration. 

We have found that the changes in 
metabolism and deterioration of tissues 
at the cellular level are usually mani- 
fested by increased acidosis, by the 
change of various enzyme levels in blood 
and tissues and by other hypoxic 
changes in the body chemistry. In addi- 
tion, there is a disruption of the body de- 
fense mechanisms which, in turn, affect 
auto-regulatory mechanisms in the cell 
resulting in further deterioration and 
death. 

At the present time the important ques- 
tions regarding pathophysiology seem to 
be at the cellular and subcellular level 



and much of the research is directed 
toward understanding the cellular re- 
sponse to injury. Changes at the cellu- 
lar level are reflected by changes at the 
organ level; for example, alterations in 
kidney cells are associated with altera- 
tions in kidney function. The kidney is an 
important target organ in shock and 
renal failure often results. Improved 
methods of treatment are needed to pre- 
vent renal failure from becoming a limit- 
ing factor in patient survival. 

Since many of the cellular alterations 
result from hypoxia, the total respiratory 
function of the patient is extremely im- 
portant. We are monitoring respiratory 
function using on-line computer analyzed 
data in order to learn more about total 
oxygenation from the whole body to the 
cell level. Efforts are being directed to im- 
prove diagnosis of tissue hypoxia and to, 
thereby, improve treatment. Changes in 
the lung in shock, sometimes referred to 
as the "shocked lung" are poorly under- 
stood but may be important in producing 
tissue hypoxia. The liver is also an im- 
portant site of alteration in shock and in- 
creased lysosome formation in death of 
cells in the parts of the liver lobule seem 
to be responsible for alterations in liver 
function, often manifested by jaundice 




Figure 1. Electron micrograph of a liver biopsy 
from a patient suffering from a head injury. Por- 
tions^of three hepatocytes (H,, Hj, H:;) can be 
seen. The liver morphology is relatively normal. 
The bile canaliculus (Bl) is located at the lower 
border of the micrograph and shows microvilli 
protuding into the lumen. Occasional lipid drop- 
lets (L,,) are seen. The nucleus (Nu) of hepatocyte 
1 is seen at the upper left. Stacks of rough sur- 
faced endoplasmic reticulum (RER) and mitochon- 
dria (M) are seen throughout the cytoplasm. 



Figure 2. Electron micrograph of a sample of liver 
from a patient who had experienced several 
episodes of shock. The chronic nature of the cellu- 
lar injury is evidenced here by the large numbers 
of autophagic vacuoles (Av), which can also be 
referred to as lysosomes or residual bodies. Note 
the bile canaliculus (Bl) is distended, and there 
is loss of microvilli. The nucleus of hepatocyte 1 
(HO is seen at the upper left, and lipid droplets 
(L,,), mitochondria (M), and microbodies (Mb) are 
seen in the cytoplasm. 



and by presence of abnormal enzymes in 
the blood stream. Using serial biopsies 
and autopsy material, we are trying to 
further the understanding of liver altera- 
tions in shock. 

Research on head injury constitutes an 
important feature of many kinds of 
trauma, since brain death can occur even 
if the remaining portions of the body are 
functioning normally. Specifically, efforts 
are being directed toward understanding 
the role of cerebral edema in producing 
brain death. It is possible that some pa- 
tients may be saved by preventing exten- 
sion of brain damage to other regions. 

Thus, the concept of a multidisci- 
plinary clinical study of trauma as it 
relates to the severity of the injury and 
its time duration has not been previously 
attempted until the Maryland program 
was established. Also prior to this pro- 
gram, no attempt had been made to 
study injury with emphasis on an exami- 
nation of the biochemical, bacteriological, 
physiological, microvascular and struc- 
tural alterations produced by tissue per- 
fusion deficits in order to develop newer 
concepts in therapy. As a result, a 
trained group of shock research investi- 
gators and clinicians have come together 
to study and treat shock and trauma in 
man without interferring with the resusci- 
tation; in fact, our studies improved re- 
suscitation. 

Basic fundamental information has 
been gleaned from the study of over 
1,100 patients. The results obtained 
from these data and the experience de- 
rived from a study of a large population 
has done much to assist in the formula- 
tion of new concepts of therapy and re- 
search. 




FUTURE 

The aim of the trauma program is to 
expand the first major trauma program 
in the country by further developing the 
present, already established trauma cen- 
ter into an eight floor building and to 
further implement the concept of the 
multidisciplinary team wherein the neuro- 
surgeon, the orthopedic surgeon, the 
chest surgeon, the internist, and the 
anesthesiologist all meet the critically ill 
on arrival and use their individual exper- 
tise to engage this killer. 




In the future the staff will continue to 
provide the best care available for the 
emergency critically injured patient and 
to further develop research techniques to 
standardize and improve patient care. 
This includes expanding multidisciplinary 
research investigations at the total body, 
organ and tissue level. A teaching and 
training program will be structured at the 
medical school, graduate training and 
community physician level. And, in addi- 
tion, paramedical training programs will 
be established for those personnel who 
are directly involved with the accident, 
such as amublance, state and local po- 
lice personnel. 

Additional goals for the future are the 
orientation of the medical profession to- 
wards the urgency of the trauma problem 
and the development and modification of 
the rapid transportation system utilizing 
helicopter support. 

Public apathy to the mounting toll 
from accidents must be transformed into 
an action program, continuing research 
and formating emergency facilities to 
provide the emergency critically injured 
with the best treatment available, imme- 
diately. 



25 



potpourri 

surgery head 

George Robert Mason has become the 
tenth surgeon to head the Department of 
Surgery. School of Medicine, since its be- 
ginning in 1807. 

In announcing this appointment which 
was effective July 1. Dean John H. Mox- 
ley III commented: 

"We are really thrilled that Dr. Mason 
has accepted our offer to become profes- 
sor and head of the Department of Sur- 
gery. He is not only a distinguished 
surgeon but an active teacher and in- 
vestigator. These attributes combined 
with an interest in the broad problems 
facing medical education and medical 
service make him a natural for the job of 
building the best Department of Surgery 
for our school." 

Dr. Roy Cohn. acting chairman of sur- 
gery at Stanford, in a letter regarding 
Mason's appointment called him "one of 
the finest young men I have ever seen in 
the program. Aside from his personal at- 
tractiveness, he has a very broad interest 
in the general problems of medicine, as 
well as in his own field of abdominal sur- 
gery and thoracic surgery." He also pre- 
dicted that Mason will be "one of the 
leading men in the country." 

Mason said his plans include "continu- 
ing the fine tradition of clinical teaching 
and care presently being offered: devel- 
oping research in areas of interest to 




myself and others in the department: 
exploring different methods of teaching, 
and expanding the staff as the hospital 
expands." 

His interest in medical education has 
been evidenced by his work on the elec- 
tive curriculum which recently went into 
effect at Stanford. "My interest in medi- 
cal education is not limited to the stu- 
dent: I am also interested in graduate 
and postgraduate study." he stated. 

The Rochester, N.Y. native received 
his B.A. from Oberlin College, his M.D. 
with honors from the University of Chi- 
cago, and his Ph.D. in physiology from 
Stanford. 

He completed the residency program 
in general and thoracic surgery at Stan- 
ford and joined the faculty rising to the 
rank of associate professor. While at 
Stanford he pursued research in gas- 
trointestinal physiology. He was a mem- 
ber of committees in charge of surgical 
curriculum and also in establishing the 
elective curriculum currently being used 
at Stanford. Other committee work in- 
volved selection of students, surgical in- 
ierns and residents and the medical 
dean. 

Prior to Stanford he served his intern- 
ship at the University of Chicago clinics 
and- served as flight surgeon in the U.S. 
Air Force. 

His honors include membership in 
Alpha Omega Alpha: diplomate, American 
Board of Surgery: diplomate. Board of 
Thoracic Surgery: the Giannini Fellow- 
ship, and the John and Mary R. Markle 
scholarship in academic medicine. 

In California, he was affiliated with the 
Stanford University Hospital, the Palo 
Alto Veterans Administration Hospital 
and the Santa Clara Valley Medical Cen- 
ter. His professional memberships in- 
clude: the Stanford Chapter. Sigma Xi; 
the Association for Academic Surgery; 
the California Medical Association: the 
American Medical Association: the Santa 
Clara County Medical Society: the Ameri- 
can College of Surgeons: the Society for 
Surgery of Alimentary Tract: the Ameri- 
can College of Chest Physicians: the San 
Francisco Surgical Society: the Bay Area 
Vascular Society and the Pacific Coast 
Surgical Society. 

Dr. and Mrs. Mason attended Oberlin 
College together and are the parents of 
three children, Douglas, Marcia and 
David. 




continuing 
education 



The in-service program for 1971-72 
has been announced by Dr. Ephraim T. 
Lisansi<y, chairman and director, Commit- 
tee on Continuing Education. 

The purpose of the program, which is 
designed for each enrollee individually, is 
to expose the practicing physician to the 
most current concepts in the practice of 
medicine, surgery and their various spe- 
cialties. 

Physicians will participate in the de- 
partment's routine scheduled program of 
rounds, clinics and conferences. He will 
be the guest of the division or depart- 
ment with which he affiliates. Ample al- 
lowance will be made for collateral read- 



ing in the library and for attendance at 
chief of service rounds, resident rounds 
and grand rounds, if desired. 

This program also allows for cross-dis- 
ciplinary visiting, or the entire period 
may be allocated to one specific subject. 

Minimum enrollment is for five days 
and the training is not available during 
June-September. Longer periods may be 
arranged with approval of the Committee 
on Continuing Medical Education and the 
department head involved. 

Further information about applications 
may be obtained from the Committee on 
Continuing Education, 201 Davidge Hall, 
522 W. Lombard St., Baltimore. Md., 21201. 



27 







1 i-ifti 




admissions and curriculum 

changing medical education 



Ij Robert Shannon, M.D. 

There are many differences between 
the way we in my generation view the 
world and the way you and your genera- 
tion view the world. Many of these differ- 
ences are not so much experimental as 
they are trying, at this point in time, to 
live up to the ideals which you have 
made for us and yet you are unable to 
! fulfill. 

The alumni is probably one of the 
most important parts in changing the 
curriculum. Many of the queries students 
are making are related to wondering what 
will happen once they get in practice as 
compared to what they are being taught. 
And, you are the only people who can 
help answer that question because you 
are working in the community. You pro- 
vide the community's needs and work on 
its problems as well as deliver medicine. 
You are the ones who see 90 per cent of 
the patients that are seen in this coun- 
try, very few of whom end up in a hospi- 
tal. For that reason, you are important in 
changing the curriculum of this school. 

How do others view Maryland? When 
asking what people know about Maryland 
School of Medicine they reply that we 
have a reputation of being an average 
quality clinical school. Much of this is 
due to the fact that few of our graduates 
go outside the state, most remain at the 
school or in the state. 

Also, the faculty as a whole has made 
no decision as to what they are here to 
do other than "educate doctors." 

In this day and age most of my col- 
leagues and myself find this an inade- 
quate answer. Most importantly the ques- 
tion that has to be answered is, "What 
are our graduates to be trained for?" Are 
they to be trained for the medicine of 
Flexner and his time? Are they to be 
trained for the medicine of the 50's? Or 
are they to be trained for the medicine of 
the 70's, 80's, 90's and even into the 
next century. Frankly, realizing that I will 
spend the next 40 years in medical prac- 
tice, I would prefer to be trained for that 
longer period of time rather than in what 
others before me have been taught. 




What then does this mean? After mak- 
ing the decision about what we have to 
be trained for then we must find out how 
we accomplish this goal. We don't do 
that by saying, "Well, what is everybody 
else doing and how does that apply to 
us?" We are different. We are Marylan- 
ders. Most of the students come from in- 
side the state although their educational 
experience in college is diversified. But, 
we are different as each school is differ- 
ent. No one procedure in medical educa- 
tion will suffice for all schools. 

Therefore, we must experiment. Many 
schools have used special programs af- 
fecting a small amount of medical stu- 
dents to try new teaching methods rather 
than moving ahead on a full scale. Some 
questions should be asked: What do we 
want students to learn? How can we 
bring students to learn faster and more 
efficiently? 



Ed/tor's Note: Drs. Shannon, Ramsay and Weaver delivered their views on admissions and curriculum 
during Alumni Day activities. June 3, 1971. Shannon is currently an intern at Montefiore Hospital, Bronx, 
N.Y. Ramsay is assistant dean for student affairs and Weaver is associate dean for admissions. 



29 



There are kinds of experiments we 
must conduct. The elective system which 
was started this year in the senior year 
is an experiment and its value won't be 
known for several years. We are behind 
in our willingness to experiment. Other 
schools have been using the elective sys- 
tem for as much as four years. They 
have solidified their program and found it 
does work. I have seen other educational 
systems, particularly in Colorado, and 
have seen other ways of teaching medical 
students. I have also met other students 
at my level who had experienced other 
methods of learning. 

Many of the stalwarts of medical edu- 
cation — Western Reserve, Harvard and 
others — already know that for their type 
of people in their type of institution 
many of the new methods don't work. We 
again still do not know and we cannot 
apply their data to what we are talking 
about. 

You and your colleagues have said 
that some of the things you experienced 
or were taught in medical school, many 
of the same things we are experiencing, 
were useless in the real world. This is a 
critical factor and the question of rele- 
vance to practical day to day practice 
must be examined in each one of the 
courses. That is one of the major con- 
cerns of the student and we need your 
help. 

No longer can we say that what was 
good enough for me will be good enough 
for those who come after me. You don't 
want that for your children. And we don't 
want it for the graduates of the Univer- 
sity of Maryland. We must continue mov- 
ing toward some better method of edu- 
cating those who come behind us. 

Generally, we find the faculty, with 
notable exceptions, slow to change, irri- 
tated by challenge, unwilling to experi- 
ment and whose teaching is secondary to 
all else. And rewards such as tenure, po- 
sition, etc. from what we have observed 
place teaching quality far behind other 
criteria. This is one of the most perplex- 
ing things to us as students. 

We have grave questions about the 
competency of the graduates — about our 
own competency and it's not related to 
the elective system. It is related very - 
much to the teaching we've received. 
This is not the classroom teaching, but 
the one-to-one contact which we all know 
is the most valuable experience one can 




have. This is the opportunity to compare 
that one-to-one contact, that clinical im- 
pression or clinical method that we read 
about in textbooks to actuality. 

Many, many of my class, about 34 
graduates, are not going out to find out 
what else is going on in the world be- 
cause they are remaining here. One of 
the faculty called this a severe tragedy in 
the commentary on education at this 
school since this represents a type of in- 
breeding. Those who stay will continue to 
believe that they have something good 
without ever questioning and asking: "Is 
what we have the best that we can offer 
to the students as an educational proc- 
ess and to the people of Maryland as a 
major hospital?" 

What possibilities do we have in the 
way of curriculum models? 

There are certain options that can be 
taken. One which could come out of the 
curriculum meeting (June 13-15) due to 
a lack of consensus is that we continue 
the same procedures that we have used 
over the last several years. This answer 
is totally untenable to us as students in 
relation to today and the 20th century 
and tomorrow and the 20th century. 

The systems process requires a tre- 
mendous commitment of the faculty and 
I question whether we have that commit- 
ment from our faculty. This means teach- 
ing in a near disciplinary fashion which 
requires a lot of time, a great deal of 
commitment and a lot of interdisciplinary 
meetings to provide the best education to 
students. 




The elective system is possibly an op- 
tion and certainly a problem. There is 
something to be gained in moving to an 
elective system — freedom for an individ- 
ual to make decisions about his further 
education. However, if good counseling is 
given students or even bad counseling 
for that matter, you most often will find 
them (students) unwilling to break with 
traditional lines. They take the traditional 
courses because they feel that this is 
what they need. 

Credentials for admission are another 
important factor to be considered. Every- 
one has to use credentials for something. 
I I would ask you very seriously to exam- 
ine what those credentials set for admit- 
tance mean. It has already been well 
proven that credentials obtained before 
medical school make no guarantee of 
performance in medical school outside of 
being able to say that a person can gen- 
erally handle the workload. 

Many of my classmates kiddingly com- 
ment that under the present system you 
could take a monkey and train him for 
the first two years. If one of you would 
come with us for a day of classes or 
maybe a week of classes and sit for 40 
hours you can see for yourself what hap- 
pens. Often times the lights are out with 
the projector going and having stayed up 
until midnight studying, you can't stay 
awake under those conditions. Assimila- 
tion of facts usually occurs the night be- 
fore the exam. 

Then, what do our credentials mean? 
They mean little in the sense of whether 
I we are going to turn out good physicians 



or not. They mean only that we have peo- 
ple who can assimilate material rapidly, 
have done an excellent job of it and have 
been selected for it in the education sys- 
tem up to that point in time. 

Students have been trained well in 
memorizing and we do not need to rein- 
force it. What we need to reinforce is 
something that all you gentlemen took 
years in learning — how to approach a pa- 
tient who walks in your office with a com- 
plaint without lab data, without having 
him hospitalized and without having the 
confinement you need for examination . . . 
how do you determine whether he is ill 
or not? Not how do you diagnose the un- 
treatable disease, but how do you make 
sure that somebody knows how to diag- 
nose the treatable disease? 

Therefore, you must begin to empha- 
size how to use your brains and senses, 
all five senses and even the sixth sense 
that said: "This is a patient in trouble, 
and I can't let him walk out of here." We 
are not presently training people for that. 
We are training people to see patients as 
ihey come into a hospital most often a 
severely-ill patient. Many of my col- 
leagues, including myself, have missed 
many diagnosable, treatable diseases 
that we should not have missed. I do not 
blame entirely the teaching system at the 
University of Maryland, but I also blame 
myself because some place along the way 
I missed something. The question of 
competency here is not so much my fear 
of internship, which is very real, but I 
wonder if I have received the best educa- 
tion available. And I think that is the 
question that all of us have to ask our- 
seives with respect to this school. 

Secondly, are we willing to experiment 
to find out better ways of teaching the 
incoming professional and to prepare him 
to use his brain since the facts will 
change and probably be obsolete by the 
time he's five years out of his first two 
years and even after three years of medi- 
cal school? Those are the things we have 
to handle — obsolete facts. Are we train- 
ing a man to use those faculties which 
he will carry with him for the next 40 
years in practice? 

And finally, are you gentlemen going 
to become involved? I sincerely hope you 
will because you are the ones that have 
at hand many of the answers to ques- 
tions that we as undergraduate medical 
students are asking. 



31 



curriculum changes 

Frederick J. Ramsay, Ph.D. 

The responsibility of providing a better 
education is one that falls on the faculty 
of this school. This does not take away 
from the education that the present stu- 
dents' predecessors had, but there are a 
number of things going on in society, in 
the profession and in the educational es- 
tablishment which conspire to bring 
about a need for change. 

Some of these changes come from the 
sociological media in which we operate: a 
requirement for better health care; a re- 
quirement for more availability of physi- 
cians, which may mean more numbers of 
the same number of physicians, but more 
available, and systematic changes in the 
delivery of health care. People are asking 
for the best of available procedures and 
techniques in the area of health care. 
From a technological point of view we 
have more therapeutic agents, new proce- 
dures and new techniques which must be 
included in our educational process. 

On the other hand, in the business of 
educating there are new ways to teach, 
new ways to do things, new ways to 
use computers and programmed instruc- 
tion of various sorts including television. 
From the profession itself come pres- 
sures to change with the eventual loss of 
the internship as a part of postgraduate 
education and changes in postgraduate 
education. Finally, but not unimportantly, 
are the students' needs. We have a dif- 
ferent brand of student coming to school 
today who views the world and his educa- 
tion in a different way. 

All of these things work together to 
produce about four major trends. These 
four major trends seem to be paradoxi- 
cal, but yet we must deal with them all. 

The first trend is the increasing num- 
ber of students that we are going to have 
to educate, sooner or later. Secondly, 
there is going to be an Increase in the 
content with shifts In emphasis of what 
we teach. Also, there is going to have to 
be a shift in how we view a teaching pa- 
tient. A patient in our service area is_ 
teaching material, but he is also a pa- 
tient. With the construction of a high- 
class delivery system, he's a patient first 
and teaching material secondarily. And, 




finally there is going to be a relative 
shortening of the time for training. 

Now the first three problems seem to 
require more time, more effort and the 
last means we're going to have to com- 
pact time and effort. This means that we 
are going to have to find new, more 
efficient ways to teach. 

In 1966 the first curriculum modifica- 
tion was introduced in the freshman 
year. The organizing principle for that 
year was temporal correlation. We hoped 
to achieve more efficiency by having 
those areas which covered the same kind 
of material in anatomy, physiology, 
biochemistry and other basic science 
courses taught concurrently. 

The following year systems teaching 
was included in the second semester of 
the sophomore year. Then in 1969 we 
changed the third and fourth year, so 
that the junior year is now clerkships and 
medicine, surgery, obstetrics and gyne- 
cology, psychiatry and pediatrics. The 
senior year has a 12-week block in am- 
bulatory care and anesthesiology, radiol- 
ogy and ophthalmology and then 24 
weeks of free electives that the students 
can choose in whatever specialty they are 
interested in and wherever they like to 
take it. 

Some of our changes did not endure. 




The first year the method of temporal 
correlation simply didn't work very well. 
That is not to say we lost it all; we did 
retain some of the good things that came 
out of it — we've reduced laboratories 
considerably and introduced new mate- 
rial. 

The second year with its systems 
teaching in the second semester is hold- 
ing up, but is under severe pressure for 
change. The third and fourth year seem 
to be pretty solid. 

For the last two years the curriculum 
committee has been studying the first 
two years — the so-called basic science 
years. It has attempted to find some way 
in which we can make that block of time 
meet some of the requirements men- 
tioned previously. It is an extremely diffi- 
cult job to do. 

The curriculum committee has recom- 
mended setting up three model curricula. 

The first of the three models is a 
systems approach: for the first two years 
everything would be taught in an orienta- 
tion around a central core which may be 
pathophysiology or some other organizer. 
That means that anatomy, biochemistry, 
pharmacology, all first and second year 
subjects would be combined together to 
produce a single unit in a systems ap- 
proach. 




The second model offered is called the 
"basic science, clinical science mix." It 
proposes a first year of highly com- 
pressed basic science courses. The sec- 
ond year puts the students immediately 
into clinical areas where they will per- 
form tasks that they are capable of con- 
ducting while they learn the rest of their 
basic science. Then the third and fourth 
year will be pretty much as they are now. 

The final model is an elective model. 
Three or four prerequisite courses that 
everyone must take will be established 
and then the students will select the 
courses and build their own curriculum. 
This could be done either of two ways: 
alternative tracks to a single goal or al- 
ternative tracks to alternative goals. A 
basic decision that must be made is: Are 
we going to produce different kinds of 
M.D.'s, but allow the student to arrive at 
that point his own way or shall there be 
one "product" at the end of our training 
program? 

My one regret is that we really haven't 
had a chance to tap the alumni. Those 
of you who are in the practice of medi- 
cine could give us some very valuable in- 
sights as to what students need in the 
general practice of medicine. We some- 
times, I'm afraid, get a little parochial 
here because we are so wrapped up in 
our own system. 

I will try to keep you posted as to 
what's happening and where we are 
going with the curriculum. It's an excit- 
ing time but it also carries with it some 
anxieties. Your profession is a very com- 
plicated profession and the training for it 
is even more complicated. 



33 



admissions 

Karl H. Weaver, M.D. 

Admissions, not only at this school, 
but at every medical school in the coun- 
try, probably can best be described in 
the words "increasing competition." This 
is true both for the numbers of individu- 
als who are applying to medical schools 
and the strength of the credentials that 
they present in support of their applica- 
tion. 

There is no question that the number 
of individuals who want a career in medi- 
cine far exceeds the number of places 
available in today's medical school classes 
in the United States. This is a very sad 
and tragic situation and certainly repre- 
sents a tragic loss of human resources. 
What has happened nationally in that ten 
year period can be seen below: 



First Year 




No. Persons Places 
Year Applying Available 


Applications 


1961 14,381 8,483 


53,832 


1966 18,250 8,991 


87,627 


1971 26,000'' 11,800' 


165,000'= 


" estimated 

Source: Association of American 
leges. 


Medical Col- 



From 1961 to 1966 there has been a 
fairly large increase in the number of in- 
dividuals applying to medical schools. 
They generated an increasing number of 
applications, but during that period there 
was a relatively minor increase in the 
number of first year places. We have 
made a much better progress across the 
country in the past five years, but again, 
for 1971, 26,000 individuals are apply- 
ing for 11,800 places and these 26,000 
people are generating 165,000 applica- 
tions. That is the national picture. 

What has happened here at the School 
of Medicine? 

First Year 



Resident No. Total No. 

Total No. Appli- Class Residents Requests 

Year Applicants cants Size In Class To Apply 



1961 456 

1966 621 

1971 1,080 



173 
270 
508 



100 
128 

137 



N.A. 1,000 

100 1,785 

134 2,268 



As shown above, here again at Mary- 
land it is a case of increasing numbers 
of individuals applying. In 1961 we had 
1,000 people who requested an initial 



application. Maryland uses a two-stage 
application process. For the second 
stage, 456 applicants generated a final 
application. In the second stage group 
are all Maryland residents and all individ- 
uals who identify themselves as legacies. 
A legacy is defined as sons or daughters 
of graduates of this school. Of the 456 
second stage applicants, 173 were Mary- 
land residents. At that time (1961) there 
were 100 places in the first year class at 
the School of Medicine. 

Five years later, the figures had grown 
— 1,785 requests to apply were received 
and that group was reduced to 621 final 
applications. In that final application 
group were 270 Maryland residents. The 
first year class at that time was 128 of 
which 100 were residents. This year over 
a thousand people generated a final ap- 
plication of which 508 were Maryland 
residents. There has been an unbelieva- 
ble increase in the Maryland resident 
pool in the past five years. This year the 
class size will be 137 and there will be 
three non-residents in the class. 

Even though the number of applicants 
is increasing, the strength of the creden- 
tials that they present is increasing also. 
So it's not a case of more people diluting 
the strength of the credentials which are 
submitted in behalf of their application. 
This year was an exceptionally keen and 
competitive year and it will most likely 
continue to grow keener each year. 

The objective data of the applicant 
pool applying to enter in 1968 and 1971 
is shown below. MCAT stands for Medical 
College Admissions Test and GPA is the 
over-all grade-point-average calculated 
on a 4.0 basis (A is 4.0, B is 3.0, etc.) 



Application Pool 

1971 

MCAT Scores Res/dent Non-resident 



Verbal 

Quantitative 

General 

Information 

Science 

GPA 



549 
586 

550 
535 
2.93 



576 
611 

576 
565 
3.24 



1968 
Res/dent 

540 
569 

561 
540 
2.82 



This increase in numbers has not rep- 
resented individuals with less competitive 
credentials. In 1968, 323 Maryland resi- 
dents applied and 508 applied in 1971. 
For 1971 the residents who applied have 
essentially the same MCAT scores, but a 
higher GPA, and there are 200 more peo- 



pie in this pool. Thus, a great segment of 
those have very strong credentials. For 
comparison, the data of the non-resident 
pool for 1971 is also listed. 

Because of the increasing strength of 
the applicants' credentials it is obvious 
that the objective data of the classes 
which have been selected would be 
changed somewhat as is indicated: 





Objective 
Entering 


Data 
Class 




MCAT Scores 


1962 


1966 


1971 


Verbal 


534 


542 


570 


Quantitative 


517 


580 


627 


General 

Information 


528 


568 


566 


Science 


521 


540 


567 


GPA 


2.80 


2.93 


3.31 



* as of June 4, 1971 

Over the past ten years, there has 
been a rather marked increase in the 
objective data of the first year class. 

As an interesting sidelight, look at the 
class that was admitted in 1966 and 
compare that data with the objective data 
of the resident applicant pool for 1971. 
This gives you an idea of what has hap- 
pened over a five-year-period. The class 




that was admitted in 1966 had virtually 
the same credentials as the total resident 
Maryland pool does for this year. 

These data represent the background 
within which the Committee on Admis- 
sions must make their selections. The 
committee is composed of twelve individ- 
uals, eight of whom have primary teach- 
ing responsibilities in the clinical sci- 
ences and four of whom have primary 
teaching responsibilities in the preclinical 
sciences. The group as a whole reviews 
all the credentials that are submitted by 
the applicant, paying particular attention 
to the academic record; the MCAT 
scores; letter of evaluation — which are 
usually received from the undergraduate 
college premedical committee; the inter- 
view, and all other credentials which in- 
clude whether a person has an advanced 
degree, their job experiences, their activi- 
ties at school and their contributions to 
their college community. Sometimes age, 
and whether they are a legacy are fac- 
tors. 

Applicants selected from the second 
stage are interviewed by one member of 
the committee and one member of a pool 
comprised of approximately 50 faculty 
members, 20 senior students and about 
10 house officers who have been se- 
lected to conduct interviews. All of these 
are individuals who have indicated their 
willingness to participate in the admis- 
sions process. They submit a written re- 
port of the interview as does the com- 
mittee member himself. The entire 
committee meets once a week during the 
application season, which now runs from 
early September through March and 
sometimes April. 

I can't stress the amount of time that 
the individual members devote to this. 
They devote at least a full day a week 
and probably more. Certainly they have 
my undying appreciation for the work 
that they have done. 

All decisions are made by the entire 
committee, meeting and reviewing the 
particular applicant's credentials at one 
time. All of the factors within the appli- 
cation are taken into consideration, a full 
discussion ensues and then, at some 
point in time, the committee makes a yes 
or no decision. Essentially what they 
have to do is take a pool of about 2,200 
applicants, make a yes or no decision 
and come up with a class of 137. 



35 




The decisions can be alikened to a 
clinical decision as much as anything. 
The committee examines all of the data 
presented and then makes a final deci- 
sion in light of that data. As we have 
seen, strong competition exists and the 
committee must make their decisions in 
light of that competition. 

One of the problems that exists in all 
state universities, all state supported 
schools, is the same one v/e are facing at 
Maryland. That is, that as the number of 
Maryland residents increase — the num- 
ber of people applying in the applicant 
pool from the state of Maryland — and 
certainly as their credentials remain at a 
very high level, there will be no question 
that the Committee on Admissions will be 
able to select fewer and fewer out-of- 
state students. Unfortunately this means 
that legacies who are from out-of-state 
are going to have to compete in the out- 
of-state pool. I would predict that over 
the next several years, until there is a 
significant increase in the class size of 
medical schools all over the country, that 
the ability of admissions committees to 
admit non-state residents to state 
schools will be limited. 

What has been the number of legacies 
who have applied in the past few years? 
Figures for the past three years available 
are: 

Legacy Data 







1969 


1970 


1971 


No. 


Applying 


26 


35 


34 


No. 


of Residents 


12 


15 


20 


No. 


Sent Offer 


14 


15 


11 


No. 


Withdrawing 


1 


2 


5 



In 19G9, 26 legacies applied; 35 in 
1970 and 34 in 1971. The number of 
Maryland residents, those sent offers and 
those who withdrew, is indicated. 

The legacy situation is one of which 
the Committee on Admissions is aware 
and they are very much concerned. But 
again, we have to view it in light of the 
background of the competition which ex- 
ists among the increasing number of ap- 
plicants with extremely strong creden- 
tials. 

What is the prospect for the future? 

In 1962, the school increased its class 
size from 100 to 128 and in 1968 the 
class size expanded to 137. Upon com- 
pletion of the North Hospital now under 
construction, the class will go to 155 
and when the addition to Howard Hall is 
complete the entering class will number 
163. Data is currently being collected as 
to the facilities and resources necessary 
to expand the class size to 200. I hope 
that day comes much sooner rather than 
later. 

My plea is that all of us who have a 
special interest in medicine, combine our 
energies and our individual talents with a 
goal to provide the facilities and the re- 
sources necessary for the continued ex- 
pansion of the School of Medicine and to 
allow it to continue to provide a high 
quality educational experience. 



the academi 
medical ce 
resent 
nd future 



)hn H. Moxley III 




\\y 



It is difficult for many people in our 
society to understand the academic medi- 
cal center. It is even difficult for many 
people who are within the academic med- 
ical center to understand it. What hap- 
pens is that observers look and at first 
glance note that medical schools are 
spending large sums of money in educat- 
ing a relatively small student body. As- 
suming a national medical student body 
of 38,000 students, an observer finds 
that the total cost per year per medical 
student approaches $40,000. Further- 
more he notes in return for such large 
expenditures, society is receiving only 



9,000-10,000 graduating physicians an- 
nually. 

Unfortunately observers usually do not 
go any further and therefore do not real- 
ize that the analysis above is simplistic 
and very misleading. The reason it is 
misleading is that the undergraduate 
medical education program — the most 
apparent element of the academic medi- 
cal center — is also one of the smallest 
parts. What you are looking at is an ice- 
berg with the medical school being the 
only visible part, but where almost all of 
the activity takes place underneath. I 
refer here to the teaching hospital, to the 



Editor's Note: Dean Moxley's remarks are excerpted from a talk delivered to a curriculum meeting held 
June 13-15 at College Park. 



37 




graduate program that is producing 
Ph.D. candidates in the biological sci- 
ences, to the ambulatory services, to 
basic and clinical research, and to the 
clinical laboratories. 

Allow me to expand on the concept of 
the academic medical center. What are 
its responsibilities? First of all in terms 
of education we have undergraduate 
medical students, graduate medical stu- 
dents (interns and residents), graduate 
students in the biological sciences, and 
several types of postdoctoral students in 
both preclinical and clinical departments. 
In addition most academic medical cen- 
ters are also charged directly or indi- 
rectly with the education of various types 
of allied health personnel. We at Mary- 
land are specifically charged with the 
education of physical therapists, medical 
technologists and radiology technicians. 
Academic medical centers also provide 
continuing education for a large number 
of health professionals. All of these edu- 
cational services are provided by a single 
faculty — the medical school faculty. 

In terms of patient care it is a fact 
that one out of every nine hospitalized 
patients is in a university teaching hospi- 
tal, that one out of every seven babies 
born is delivered in a university teaching 
hospital, and that these same hospitals 
provide one out of every seven ambula- 
tory visits. It has been said that Mary- 
land and Hopkins jointly account for ap- 
proximately 50 per cent of the daily 
physician-patient contacts in the city of 
Baltimore. Again let me emphasize that 
the patient care is provided or supervised 
by the medical school faculty. 



What about research? Without recount- 
ing all of the incredible benefits of the 
biomedical revolution let me simply point 
out that as long ago as 1967-68 medical 
schools were charged with the spending 
of over $473 million for sponsored re- 
search. If you add the research effort of 
teaching hospitals, you must add another 
$150 million. The fruits of this research 
have benefited our entire society. Once 
again the medical school faculty has 
shouldered the responsibility. 

Extramural services are a new and 
rapidly growing responsibility of aca- 
demic medical centers. These services in- 
clude participation in the organization 
and operation of community health cen- 
ters of which our prime example is the 
Community Pediatric Center. Also in- 
cluded, however, is participation in re- 
gional planning efforts where medical 
faculty are viewed as important members 
of the various committees and as consul- 
tants at both the local and national 
level. 

Participation in public health programs 
is yet another important function of the 
medical faculty. Local participation can 
be seen in the Inner-City Community 
Mental Health Program, which literally 
would not have gotten off the ground had 
it not been for our Department of Psy- 
chiatry. 

To recapitulate, the activities of the 
academic medical center in the United 
States can be set forth in the following 
terms: education and training for about 
275,000 health professionals and tech- 
nologists, of whom about 65,000 are 
physicians at some stage of their train- 
ing; continuing education of over 
100,000 practicing physicians; the provi- 
sion of over 46 million patient days of 
hospital care per year for over 3.5 mil- 
lion patients; the delivery and care of 
about 450,000 newborns; the provision 
of some 17 million ambulatory visits an- 
nually; conduct of over $600 million 
worth of biomedical research; and the 
provision of about $60 million of extra- 
mural services. Total expenditures range 
somewhere in excess of $4 billion per 
year. 

With biomedical research in a state of 
crisis, with the great deal of activism at 
all levels of the educational process, with 
the organization and delivery of health 
care in ferment, with inflation rampant 
and appropriations being reduced and 



with almost no money being appropriated 
at the federal level directly for under- 
graduate medical education, is there any 
wonder that medical schools are in the 
throes of a very major identity crisis? 

So much for the present; what can we 
say about the future? Despite the current 
ferment I think there are some character- 
istics of the future that we can define 
and I will now attempt to do so. 

First, it is perfectly obvious that the 
multiple roles of the academic medical 
center will continue. I, for one, do not 
see us abandoning any of our current 
roles and am equally certain that they 
will each continue to grow. 

Secondly, the academic medical cen- 
ters of this country will increasingly be 
viewed as a national resource and will 
continue to get a portion of their funds 
from the federal government. Despite a 
probable growth in support from Wash- 
ington, state support will continue to be 
critical; the state provides our core sup- 
port without which we could not continue 
to function. Furthermore, expansion of 
the medical center either in terms of stu- 
dent body or service to society will be 
dependent upon financing by the State of 
Maryland. We will therefore remain ac- 
countable to the University of Maryland, 
the State of Maryland, and to the federal 
government. I am also convinced that the 
undergraduate medical education pro- 
gram will receive increasing attention by 
all of our funding sources. No matter 
what other changes occur in the health 
field, our society is determined to in- 
crease the production of physicians. 

In terms of planning for the academic 
medical center, I have to say that we no 
longer have the capability to significantly 
alter our total mission. I am often asked 
what is the mission of the medical 
school? What specific type of physician 
are we attempting to produce? As I have 
recounted for you, we have many mis- 
sions and we are going to have more. 
There will have to be many different 
types of doctors produced in the future 
and they will be produced at academic 
medical centers. Increasingly our society 
has become dependent upon our total 
mission and this dependence is at the 
same time important and restrictive. 

I do feel strongly, however, that we 
have the capability to reorder the priori- 
ties within the academic medical center 
and I believe they need reordering. I 




would like to see us reorder our priorities 
and place undergraduate medical educa- 
tion at the pinnacle of our activities, ori- 
ent all of our other activities around it. 
Every activity cannot be directly related 
to the undergraduate medical school pro- 
gram but we can specifically recognize 
undergraduate education as having the 
highest call on our resources. We must 
demonstrate our renewed interest in the 
undergraduate medical education pro- 
gram by developing quality control mech- 
anisms that will constantly monitor our 
progress and assure faculty, students 
and society that teaching is our primary 
concern and that it is constantly being 
upgraded wherever-and however possible. 
As a first step I strongly urge that we 
immediately develop a peer review of all 
of our curricular programs. I am not a 
naive individual and I realize that there 
will be difficulty in elevating the medical 
student program to primacy, much less 
develop quality controls for it. I am, how- 
ever, convinced of the great importance 
of the changes proposed and encourage 
rapid action. Change is never easy, but 
it is desperately needed. 

As we move to reorder our priorities 
and as we move to reassess our program 
within the academic medical center I 
would put forth to you that our ultimate 
goal should be the creation of a medical 
university. In capsule, what I mean by a 
medical university is the development of 
multiple curricula leading to the M.D. 
degree. These curricula would have their 
origins in the undergraduate years and 
progression through them would be de- 
pendent upon a system of prerequisites; 
in other words, there would be no spe- 
cific time scale and there would be no 
lock-step. Simultaneously we must move 
toward opening the majority of our medi- 
cal school courses to undergraduate col- 
legiate students who do not intend to 
proceed to the M.D. degree. 



39 




What is the rationale for such a devel- 
opment? 

At the present time medical students 
are introduced to the medical curriculum 
at an exceedingly bad time. They are a 
very highly selected, indeed too highly 
selected, group who have worked ex- 
tremely long and hard before coming to 
us. They have worked hard in secondary 
school to compete for college entrance. 
They have then had to turn around and 
compete at even a higher level for en- 
trance into medical school. They come to 
medical school in a somewhat exhausted 
state and immediately find that they have 
to begin the academic competition all 
over again to prepare to compete for an 
internship and residency. 

In summary, medical students today 
are victims of a highly compartmen- 
talized, highly competitive educational 
system and by the time they reach medi- 
cal school the effects of that system 
upon them are quite apparent. Their un- 
happiness has been labeled as antiintel- 
lectualism. I reject this label. In fact I do 
not detect any great difference in the 
medical school problems concerning to- 
day's medical student as compared to 
previous generations. Today's student is, 
however, more willing to express his or 
her concern. What is expressed is the 
fact that they feel overwhelmed by the 
intensive exposure to the science of med- 
icine in the first two years of medical 
school. The response of medical faculties 
has been to pare down the exposure. I 
do not believe that restricting exposure 
to the science of medicine is wise for all 
indications are that we are going to be 
increasingly dependent upon it in the fu- 
ture. Why not, therefore, spread the sci- 
ence of medicine over a longer time scale 
and simultaneously attempt to individual- 
ize the exposure as far as possible. 



One of the first questions usually 
raised when the concept of the medical 
university is introduced is whether or not 
it would interfere with the American ideal 
of a liberal education. I think not, for 
several reasons. First, the liberal educa- 
tion concept used to be applied only to 
the collegiate years. Now, however, the 
concept and indeed much of the course 
material is presented in secondary 
school. Second is the fact that students 
of the liberal arts are expected to con- 
centrate in a special area for approxi- 
mately two of the four collegiate years. I 
contend that concentration in human bi- 
ology is just as legitimate as concentra- 
tion in economics, chemistry, political 
science, etc. For some reason it has al- 
ways been assumed that human biology 
was somehow less relevant to the human 
condition. I reject that assumption and 
make a plea for a human biology major 
at the collegiate level open to all stu- 
dents, whether or not they are planning 
to continue on to a health professional 
education. The basic science courses in 
such an environment just might become 
more exciting to the students. The major- 
ity of the courses in this new major 
should be either closely supervised by or 
actually taught by a medical school fac- 
ulty. 

The concept of a medical university 
would allow for greater flexibility in medi- 
cal education than we have now, or that 
will result from any specific curriculum 
change that is being proposed here or 
elsewhere. It would allow for a shortening 
or a lengthening of the high school to 
M.D. degree depending upon the desires 
of the student, his capability, the quality 
of his preparation, and last but not least 
his ultimate goal. It would readily permit 
the development of specific tracks lead- 
ing to the M.D. degree in a specialized 
area. This could easily be accomplished 
by allowing the medical student and the 
collegiate student to move back and forth 
across the collegiate-medical school inter- 
face which has been a fantastic artificial 
barrier in the past. For example, a stu- 
dent particularly interested in psychiatry 
could begin to pick up early or go back 
for courses in the social and behavioral 
sciences, or do the same in the rapidly 
developing field of neuroscience. One of 
the things that worries me about pro- 
grams with a special interest is that in- 
creasingly as I look around the country 



an M.D. with a special interest means 
that you spend more of your time with a 
certain clinical department while you are 
in medical school. I seriously question 
the merit of such programs. If a student 
is desirous of becoming an internist, is it 
best for him to spend four years with the 
faculty of internal medicine? No, is my 
answer. I believe that there are certain 
prerequisites within the large body of 
medical science that such a student 
should concentrate on, but these are not 
necessarily taught best by the Depart- 
ment of Internal Medicine. I'm not sin- 
gling out the Department of Internal Medi- 
cine since the same would be true for 
any clinical department. The medical uni- 
versity concept would allow the student 
to range over the entire spectrum of uni- 
versity offerings to best prepare himself 
for his career. It would provide us with 
opportunities to broaden and not con- 
strict the scientific base of medicine. 

I believe that there will also be clear- 
cut advantages for the preclinical depart- 
ments. I am worried over the fate of the 
basic sciences in medical school. Almost 
all curriculum revisions that have oc- 
curred over the last ten years have re- 
stricted them. They have restricted them 
in time and they have restricted them in 
creativity. Up to a point there is merit in 
constricting, but then you reach a point 
of diminishing returns. I am not certain 
that we have reached that point in our 
own medical school at the present time, 
but I believe that there are some schools 
that have done so and that we will reach 
it soon. 

Because of the changes that have oc- 
curred in the preclinical departments at 
medical schools, there has been a strong 
current of feeling that they should move 
to general university campuses. In my 
opinion the medical school environment 
would suffer, and suffer greatly, if this 
were to transpire because I believe we 
would lose our primary measurement of 
excellence. This primary measurement is 
generated by the preclinical faculty and it 
applies not only to them but also to the 
clinical departments and our clinical ac- 
tivities. Without the preclinical depart- 
ments in our environment I think we 
would run a significant risk of becoming 
a trade school. There would also be dis- 
advantages to preclinical departments if 
they moved to general university cam- 
puses because they would lose their 




medical, their human, orientation which 
is one of their unique characteristics and 
one that is extremely important not only 
to the medical school but to our society. 

The medical university concept would 
allow preclinical departments to continue 
their identity with medicine and would 
also allow them to maintain the integrity 
of their discipline. It would in addition 
open up to them a wider range of stu- 
dents. It would widen their educational 
role both in the medical school and in 
the undergraduate years and would pro- 
vide the stimulation of allowing their 
course offerings to be introduced earlier 
in the educational continuum from high 
school to the M.D. degree. 

Now I would like to make a few com- 
ments about clinical teaching. One of the 
few specifics that I will deal with in 
terms of the current curricula that you 
are going to be dealing with within the 
next few days is that I believe very 
strongly that there must be an earlier in- 
troduction of clinical content. 

In talking with students a word that 
continues to come up is "disaffection". 
I've not heard a satisfactory definition of 
disaffection but as I begin to listen and 
put it together one of the things that 
comes through is that it is increasingly 
difficult for students in the first and sec- 
ond years to keep in mind what they are 
really here for. What is the goal of their 
medical education? I think that this anxi- 
ety could be relieved significantly if stu- 
dents did have contact with patients 
quite early. It also just might stimulate 
their interest in science of medicine, al- 
though this is not a 100 per cent guar- 
antee. It would, however, allow them to 
be introduced to the social problems of 
medicine at a very early stage, and the 
social problems of medicine are with us 
now and will be with us increasingly in 



41 



the future. It is difficult for a student 
who is on a busy university inpatient 
service to become involved in the social 
problems presented by his patients. If, 
however, he was introduced early, when 
he did not have the total burden of re- 
sponsibility for the care of the patient, 
he might gain a lot of insight into these 
very important problems. 

We must also begin to combine our 
educational program with the other 
health professional schools on our cam- 
pus. Although some progress has been 
made in this regard, more effort must be 
devoted to bringing our students into 
joint educational experiences with stu- 
dents in the schools of nursing, phar- 
macy, social work and community plan- 
ning, and dentistry. In the future a team 
approach to health care will be essential 
if we are to meet the needs of society. 
Nobody, particularly the students, gains 
any benefit from the strict educational 
isolation currently practiced. There is 
more than a touch of irony in the fact 
that invariably at commencement the 
statement is made that we expect the 
various graduates to work closely to- 
gether after they graduate. 

The teaching and general importance 
of ambulatory care has been systemati- 
cally shunned by medical faculties since 
time immemorial. This downgrading can- 
not be allowed to continue when every in- 
dication is that more and more health 
care can and should be supplied on an 
ambulatory basis. For the past two years 
the school has been making a major ef- 
fort to improve our ambulatory care pro- 
grams and an experience in ambulatory 
care is now required of all students. De- 
spite our efforts, progress in our ambula- 
tory care programs has been insufficient. 
In part the problem rests in the inade- 
quacy of our facilities, but the major 
problem here and elsewhere is a very 
real resistance to accept the provision 
and teaching of ambulatory care as a full 
partner of inpatient care in medical edu- 
cation. The major thrust in ambulatory 
care will continue. 

Another development that we are going 
to have to come to grips with is the inte- 
gration of the undergraduate with the 
graduate medical education program. 
Graduate medical educational programs 
throughout our history have been an ex- 
tra-university function. By extra-university 
I mean that these programs have been 




exclusively controlled by the specialty 
boards and not by the faculty. A change 
in thinking is now occurring and increas- 
ingly efforts are being made to bring 
house staff education into a continuum 
with undergraduate medical education. 
The Council of Medical Education of the 
American Medical Association is making 
every effort to catalyze the development 
of the continuum of education. Specifi- 
cally the internship as an isolated year is 
to be abolished in 1975. Medical stu- 
dents will match into a program of grad- 
uate medical education of several years 
duration rather than into an isolated year 
between medical school and residency. 
The senior year of medical school will be- 
come a transitional year both in terms of 
focus and clinical responsibility. The 
focus will be increasingly on a defined 
area of medicine. 

There is a movement at the present 
time, and one that I think is important, 
to develop a corporate responsibility for 
graduate medical education. By corporate 
responsibility I mean that no longer will 
an individual clinical chief be totally re- 
sponsible for developing his own individ- 
ual program. There is going to have to 
be evidence for accreditation purposes 
that the chiefs of the clinical depart- 
ments as a group are looking at the en- 
tire spectrum of graduate medical educa- 
tion as it occurs in the medical center. 
There are very obvious possibilities in re- 
gard to quality control here. For instance 
a program in surgery is more apt to be a 
strong program if there is proven interest 
on the part of the chief of pediatrics, the 
chief of internal medicine, and so forth 
in devising that program. Furthermore it 
is highly likely that in the future only 
complete graduate medical education 
programs will be accerdited. Fragmented 
one and two-year partial programs will no 
longer qualify. 



I 




Additionally there is going to be a very 
hard look at free-standing graduate medi- 
cal education programs. To again take a 
surgical example, many people are begin- 
ning to question whether there should be 
a free-standing residency program in any 
surgical subspecialty in any hospital. I 
believe that the direction we are going to 
go is to say if there is going to be, for 
example, a neurosurgical training pro- 
gram in a hospital there must also be a 
general surgery training program in the 
same hospital, and if there is going to be 
a general surgery training program in a 
hospital there will also have to be a pro- 
gram in internal medicine in that same 
hospital. There will probably be at least 
one exception in terms of free-standing 
programs and that will be in family prac- 
tice. In my view these changes in gradu- 
ate medical education are long overdue. I 
am convinced that they will improve the 



quality of graduate medical education 
significantly. As a matter of fact the co- 
cept of corporate responsibility should 
immediately be applied to undergraduate 
clinical education. The clinical depart- 
ment heads should, as a group, look at 
the total range of clinical clerkships that 
we offer in our medical school rather 
than in isolation defining and worrying 
about their own. 

Tonight I have presented some 
thoughts about where we are now and 
some directions for the immediate future. 
I have emphasized the need for a re- 
newed thrust in undergraduate medical 
education, the need for quality control of 
medical education, and the concept of 
the medical university. By moving 'for- 
ward in conquest of these goals we have 
the opportunity to develop one of the 
most important medical education pro- 
grams in the country. 



43 



professors of surgery 1807-1907 

(part two) 



Harry C. Hull, M.D. 

There have been some outstanding 
professors of surgery during the Univer- 
sity of Maryland School of Medicine's ex- 
istence. Although the Flexner report of 
1910 suggested that the school be dis- 
continued, its survival was due to some 
of these strong men occupying the chair 
of surgery, who gained local, state and 
national prominence. 




louis mclane tiffany 

Louis McLane Tiffany (tenure 1880- 
1902) was born October 10, 1844 in 
Baltimore, Md. The son of affluent par- 
ents, he received his early education in 
private schools in New England and 
Paris. His maternal grandfather was a 
member of President Jackson's cabinet 
and was twice minister to Great Britain 
under Presidents Jackson and Polk. After 
preliminary schooling in Paris, he entered 
the University of Cambridge, England, 
where he received a B.A. in 1866 and 
later earned his M.A. While at Cam- 
bridge, he was a noted athlete, particu- 
larly in track and field events and always 
cherished the large silver bowl awarded 
him for his prowess as an athlete. 

When he returned to Baltimore in 
1866, he entered the University of Mary- 
land School of Medicine and received his 
M.D. in 1868. During these two years he 
was also the office pupil of Dr. Nathan R. 



Smith. Following graduation, he served 
as resident physician at the Bay View 
Asylum (now Baltimore City Hospital). 
After completion of the residency, he was 
appointed demonstrator in anatomy, both 
normal and morbid at the medical 
school, and acted in that capacity until 
1874. Undoubtedly, this thorough famil- 
iarity with gross and morbid anatomy was 
of the greatest importance to his eventual 
surgical brilliance. 

After finishing residency at Bay View 
Asylum, he began the private practice of 
surgery in Baltimore. At this time medi- 
cal schooling was only for two years with 
five and a half months each year. He was 
the first physician in Baltimore to limit 
his practice to surgery. 

Naturally strong in fitness, physique 
and temperament by education, cultiva- 
tion and training, he was admirably 
suited for the early surgical success 
which he obtained. He was said to have 
magnetic personality, charming manners 
and a wonderful sense of humor. He was 
delightful with children, had a great love 
for animals, and enjoyed hunting, fishing 
and physical fitness. 

In 1874 at age 36, he was appointed 
professor of operative surgery and six 
years later he was appointed professor of 
surgery to succeed Dr. Christopher John- 
ston. He became one of the more out- 
standing professors of surgery at the 
university. 

As a lecturer, he was simple, direct, 
graphic, never oratorical or rambling. As 
a student of that era said, "his manner 
was all his own, and in a peculiar way 
his lectures were effective, easy to follow, 
difficult to forget." This same simplicity 
marked his bedside teaching. He had a 
high regard for the patient's story, and 
was a gentle and excellent clinician, al- 
ways inspiring confidence in patients and 
students alike. 



Ed/tor's Note: The first part of Dr. Hull's article appeared in the July Bulletin. 



As an operating surgeon, he was de- 
scribed as slow, gentle, deliberate and 
purposeful, with profound respect for tis- 
sues. He early introduced the newer anti- 
septic methods, was meticulously clean 
and exacting. He admitted to the value of 
the new chemical disinfectants and car- 
bolic sprays, but always insisted on the 
use of soap and water. He constantly 
stressed the danger of tension in wound 
closure; was noted for draining nearly all 
wounds; and was ambidextrous, switch- 
ing the knife from one hand to the other, 
lending quite a flourish to his operations. 

Tiffany published over 70 papers in 
addition to contributing chapters to Den- 
nis System of Surgery, The International 
Text Book of Surgery, The International 
Magazine of Surgery and the Reference 
Handbook of Medical Sciences. Among 
these were papers on appendicitis, breast 
tumors, surgery of blood vessels, surgery 
of the cranium, jaws and teeth, cancer of 
the rectum, tracheotomy, kidney and 
bladder stones, nerve tumors, osteo- 
sarcomas, intussusception, splenectomy, 
esophagotomy, hernias, gall bladder dis- 
ease, to mention a few. He took an active 
interest in medical societies and was an 
ardent reader of current journals and re- 
ports. 

Some of his operations are worth not- 
ing. In 1878 he performed a temporary 
depression of both maxillae for angiosar- 
coma of both nares, preceded by trache- 
otomy. The patient survived and this feat 
received national notice. In 1885 he is 
reported as having performed the first 
successful nephrolithotomy in America. 
In 1886 he performed a successful esoph- 
agotomy. In 1893, speaking to the 
American Surgical Association, he re- 
ported four cases of complete excision of 
the gasserian ganglion — three cases were 
cured. He was credited with the first suc- 
cessful gastroenterostomy performed in 
Baltimore in 1892. These reports indi- 
cate his courageous, self-confident, and 
at times, original approach to the surgery 
of his era. 

The doctor's ability as a surgeon and 
as a man, was further attested by his 
election to the presidency of the Ameri- 
can Surgical Association and the South- 
ern Surgical Association, as well as to 
the Baltimore Medical Association, the 
Clinical Society and the Medical and Chi- 
rurgical Faculty. He was consulting sur- 
geon to the Johns Hopkins, St. Joseph 



Hospital and the Church Home and In- 
firmary. 

In 1902 at age 58, after a tenure of 
12 years, he resigned the chair of sur- 
gery at Maryland because of ill health. 

Among the testimonials to the surgeon 
was a portrait of him to be placed at the 
Medical and Chirurgical Faculty building. 

A man of means, he continued his ac- 
tive interests in medicine and a limited 
surgical practice. He spent a good part 
of each year at his summer home. Mount 
Custis, Accomac County, Va., where he 
died suddenly of a heart attack on Octo- 
ber 23, 1916. 




randolph winslow 

Randolph Winslow (tenure 1902-20) 
was born at Hertford, N.C., October 23, 
1852. He was the son of Dr. Caleb Wins- 
low, a surgeon of note, and his uncle 
was Dr. John R. Winslow, a prominent 
physician of Baltimore. His early educa- 
tion began in North Carolina during the 
Civil War. In October 1865 his father 
moved the family to Baltimore and 
placed Randolph in Rugby Academy. In 
1867 he entered Haverford College and 
received his A.B. in 1871. Three years 
later he received an A.M. (in Greek) from 
the same college. He received his M.D. 
from the University of Maryland School 
of Medicine in 1873, standing at the 
head of his class of 46. 

After receiving his M.D., he began 
practice in Baltimore and also immedi- 
ately joined the teaching staff at the Uni- 
versity of Maryland. He served succes- 
sively as assistant demonstrator of 
anatomy (1873-80), demonstrator of 



45 



anatomy (1880-86), lecturer on clinical 
surgery (1886-91), professor of anatomy 
and clinical surgery (1891-1902), and on 
the resignation of Dr. Louis Tiffany, he 
was appointed professor of surgery at 
age 50. 

During the 29 years before his ap- 
pointment to the chair at Maryland, he 
was quite active in medical affairs of the 
city. One of the founders of the Woman's 
Medical College of Baltimore, he served 
as professor of surgery there from 
1882-93. He was on the surgical staff of 
Baltimore City Hospital (Bay View), Sinai 
and others, and served as surgical con- 
sultant to the Maryland Training School 
for Boys for a quarter of a century. 

Winslow went abroad in 1883 and 
again in 1906, after accepting the chair, 
for postgraduate studies in Vienna, Ber- 
lin and Paris. 

In addition to his teaching and prac- 
tice, he found time to be unusually active 
in medical societies, nationally and lo- 
cally. He was a member of the University 
of Maryland Board of Regents for nearly 
30 years (1891-1920), and president of 
the Medical and Chirurgical Faculty 
(1914). A founder of the Association of 
American Medical College, he served on 
its executive council for 20 years. Wins- 
low was also one of the founders of the 
American College of Surgeons (1913). 
He held membership in the International 
Surgical Association, the Southern Medi- 
cal Association, the American Surgical 
Association and the Southern Surgical 
Association; served as president of the 
Southern Surgical Association (1921); 
regularly attended the American Medical 
Association meetings and was an active 
member of the Maryland Historical So- 
ciety. 

The University of Maryland is in his 
debt for his constant devotion to its med- 
ical school. Revered by his students they 
established the Randolph Surgical So- 
ciety in 1911 in his honor. This was an 
honorary society, limited to 30 seniors 
and stayed in existence for over 20 
years. During his tenure he was influen- 
tial in the building of what is now the 
"old" University Hospital (1896-97). 
Too, he was largely responsible for the 
merger of the Baltimore Medical College 
and the College of Physicians and Sur- 
geons into the present School of Medi- 
cine of the University of Maryland 
(1913-15). 



As a founding member of the Associa- 
tion of American Medical Colleges, and a 
member of its executive council for two 
decades, he was in a position to upgrade 
the school as to requirements for admis- 
sion and extending its curriculum to four 
years. In 1892, three years were required 
for graduation and in 1895 it took four 
years, but the premedical requirements 
were practically nil. In 1903, graduation 
from a four-year high school was re- 
quired for entrance. In 1914, a year of 
college work in chemistry, physics, biol- 
ogy and either French or German was 
part of the entrance requirements. By 
1918, students needed two years of col- 
lege for entrance. 

Winslow, in a testimonial acceptance 
speech in 1916, remarked that two years 
of premed'cal training was enough be- 
cause the length of time was already bur- 
densome and should not be extended. 
Today some schools are going back to 
the two years premedical plan for excep- 
tional students to shorten the long period 
of training. 

The surgeon was portly, of modest 
height and a conservative dresser. But 
seriously bent, he was a real believer in 
scholarship and diligent application on 
the part of students. His lectures ripened 
through years of practice and were given 
with clarity, fluency and force. Instruction 
from his European masters such as Lor- 
enz, Woelfler, Von Hacker and Billroth 
was passed on to his classes with au- 
thority. His earnestness and desire to 
help students with surgery earned their 
highest respect. 

As a surgeon, he was thorough, pre- 
cise and not spectacular or hasty. He 
was among the first surgeons in the 
state to practice antiseptic surgery as 
known today. Winslow is credited with 
many first in Maryland surgical practices: 
a pyloric resection for cancer (1885) 
only four years after Billroth performed 
the first such operation; a vaginal hyster- 
ectomy (1888); shortening the uterine 
ligaments (1884), and operating success- 
fully for gunshot wounds of the intestine 
(1893). He subsequently published sev- 
eral papers on the latter subject and on 
intestinal obstruction. He gave special at- 
tention to the thyroid gland and was one 
of the early operators for goiter. 

His bibliography lists 73 publications 
on a variety of subjects which were pub- 
lished in national, state and local jour- 



nals. Winslow received an honorary L.L.D. 
from St. John's College in 1909 and 
from the University of Maryland in 1924. 

Married at age 25 to Miss Rebecca 
Leiper, he sired thirteen children, twelve 
of whom survived; three daughters and 
nine sons. As busy as he was, his delight 
was his home and family. Three of the 
nine sons became doctors. 

Dr. Winslow retired in 1920, and as 
professor emeritus he continued to at- 
tend meetings, give lectures and travel. 
He died of acute myocardial infarction at 
age 85 February 27, 1937. 




arthur m. shipley 

Arthur M. Shipley (tenure 1920-48) 
was born at Harmans in Anne Arundel 
County, Md., January 8, 1878. His initial 
education was obtained at neighborhood 
schools and supplemented by attendance 
at Friends Preparatory School in Balti- 
more. Without further premedical educa- 
tion he entered the University of Mary- 
land School of Medicine and graduated in 
1902 as honor man. The following two 
years he served as intern and resident 
for Drs. Tiffany and Martin. In 1904 he 
journeyed to Europe to study pathology 
under Professor Chiari at the University 
of Strasburg accompanied by Dr. Gordon 
Wilson, who later became professor of 
medicine at Maryland. 

Upon his return, Shipley was ap- 
pointed medical superintendent of Uni- 
versity Hospital, where he served four 
years until 1908. He had complete con- 
trol of all admissions and could perform 
surgery on the patients he selected. This 
situation gave Shipley the opportunity to 
meet and know referring physicians, 



which later was the great source of pa- 
tient referral. In 1907 he was apopinted 
associate professor of surgery and in 
1914 professor of clinical surgery. During 
these years he was busy with his practice 
and teaching in the medical school. 

During World War I, he served in the 
United States Army Medical Corps 
(1917-19) as chief of the surgical service 
of the 8th Evacuation Hospital. Over 
14,000 wounded from the battles of Cha- 
teau Thierry, Belleau Woods and the Ar- 
gonne, are reported to have been treated 
at his hospital. In recognition of his fine 
war record, he was awarded the Distin- 
guished Service Medal. 

In 1920, at age 42, he was appointed 
professor of surgery at Maryland. The 
medical school following the faculty de- 
pletion in World War I was at a low ebb. 
The buildings were old, the laboratories 
ill-equipped, the bed capacity in the old 
hospital was inadequate, the hospital was 
outdated and the financial support from 
the State was parsimonious. Large fresh- 
men classes were admitted (130-150) 
and shaved down (90-100) for the sec- 
ond year. There was no committee on ad- 
missions. Though many of the faculty 
members were good teachers and excel- 
lent clinicians few had ever attended col- 
lege. There were few, if any, faculty 
members engaged in research for lack of 
background and facilities. The education 
received was almost entirely clinical. 

By 1922 there was a move in high 
places to discontinue the medical school. 
The surgeon and others lobbied in An- 
napolis for many years to save the school 
and finally their battles were fruitful. A 
new hospital and new nurses' home were 
built, and with a legacy from Dr. Frank 
C. Bressler, a new science and research 
building was possible as was reequip- 
ment of laboratories and strengthening of 
the faculty. Of greatest importance was a 
greatly increased annual support from 
the Maryland Legislature. Shipley's ability 
as an administrator was well-recognized, 
and in 1915 he became acting dean of 
the medical school. 

In 1907, five years after receiving his 
M.D., he wrote a paper in the Hospital 
Bulletin entitled "Clinical Teaching." In it 
he deplored the many and needless 
hours required of students "peering 
down the barrels" of microscopes in 
pathology. He inquired whether anyone 
practicing medicine cut, stained and 



47 



mounted tissues in their office. He thought 
freshmen students, along with basic sci- 
ence courses, should quickly be intro- 
duced to bedside teaching and become 
acquainted with illness. Today this is fin- 
ally being done. 

As a teacher, whether at didactic lec- 
tures, the operation room or bedside, he 
was outstanding. His Thursday noon clin- 
ics were always crowded to capacity. A 
striking figure of a man over 6 feet 3 
inches in height, his entrance always 
commanded immediate silence and atten- 
tion. His sobriquet "King Arthur" was 
apt. Though essentially a kindly person, 
he would stand for no foolishness. His 
were the days when the chief of surgery 
was held in awe and immediate obedi- 
ence was expected. 

The surgeon did not attend college. He 
married in 1909, and having no children 
educated himself by constant study at 
home. In his conference, it was not unu- 
sual for him to quote at length from the 
literary masters. He was a great mimic of 
pathological states of joints. His lectures 
were clear and exceptionally well-orga- 
nized. Students looked at him, listened 
and then bowed to take notes. He ap- 
peared almost as if leading an orchestra. 

In the operation room, "wet clinics" 
were the custom of that time, students 
sat gowned and masked watching sur- 
geons operate for hours each morning. 
While operating, he would give a well-or- 
ganized talk on the subject at hand. He 
even fired questions at the students in 
the gallery, and few, if any ever slept. He 
was fond of being challenged by case 
presentations at his Thursday conference, 
particularly masses located anywhere. He 
would challenge the audience with four 
"W's" — Where is it? What is it? What of 
it? and What is to be done about it? Then 
he would proceed with an excellent dif- 
ferential diagnosis — by "calling the roll 
of the anatomical structures in the re- 
lated area." 

He served for over two decades as 
chief of surgery at Baltimore City Hospi- 
tal. Dr. Thomas Boggs of Johns Hopkins, 
who served as chief of medicine at the 
Baltimore City Hospital, and Shipley gave 
unstintingly of their time to make the 
Baltimore City Hospital a valuable teach- 
ing arm for both of the medical schools 
in the city. 

During his tenure, teachers as a whole 
received no salary. He enlisted support 



of able young men and assigned them 
duties on the ward and dispensary. He 
was a tyrant to those who, regardless of 
reason missed a class, and he never 
missed a class unless he was away. Not 
often did he compliment his staff and he 
was quick to call them on the mat for 
tardiness or absenteeism. "King Arthur" 
ruled the department as well as the oper- 
ating suites. There were no committees 
for this and that, but he was approacha- 
ble and reasonable. Once a problem 
arose and he was informed of the pros 
and cons, he made a decision and it 
stuck. 

Over the years his reputation as 
teacher and surgeon grew and he was in 
popular demand over the southeastern 
seaboard as a speaker. Students long re- 
membered his as one of, if not the, out- 
standing course in the school. He held 
membership in the American Surgical As- 
sociation, the Southern Surgical Associa- 
tion, the Society of Clinical Surgeons, the 
American Association of Thoracic Sur- 
gery. Most important, he insisted his 
junior members write and publish pa- 
pers, and he was instrumental in gaining 
their election to the same top medical or- 
ganizations. He served as president of 
the Medical and Chirurgical Faculty and 
as a regent of the American College of 
Surgeons. 

In addition to his teaching, to which 
he was ever faithful, he had a very busy 
private practice. He usually operated 
upon two or three patients daily, six days 
a week, as well as handling nighttime 
emergencies two or three times a week. 
It was not uncommon for him to have 35 
to 60 patients in the hospital concur- 
rently. He was autocratic as to use of the 
operation rooms and one room was his at 
any and all times. He demanded and got 
top service above the rest of the staff. As 
a surgeon he was an unusually slow but 
careful technician. Plagued most of his 
life by an intention tremor, he was aware 
of his slowness and made up for it down 
to and including the dressing, by exceed- 
ingly painstaking work. (I think the fast- 
est appendectomy I helped him perform 
took 55 minutes.) Shipley talked and 
taught while he worked which in great 
measure compensated the assistant for 
his long hours at the operation table. He 
was an indefatigable worker, strong phys- 
ically and worked long hours most of his 
life. 



He had little time for non-professional 
activities, but did enjoy his trips to New 
Brunswick and Canada for fishing. His 
only other avocation was his rose and 
dahlia gardens. 

During his years as professor, he pub- 
lished alone and with others over 80 
papers, all of a clinical nature. These 
contributions were on varied subjects — 
pericarditis, lung abscess, empyema ab- 
dominable surgery and fractures of 
various types. Along with Dr. M. Pin- 
coffs, professor of medicine, he published 
a paper on the earliest planned removal 
of a pheochromocytoma for hypertension 
with resultant cure of the patient. 

It was during his tenure that subsec- 
tions of surgery were planned and imple- 
mented with the appointment of heads of 
urology, neurosurgery, otolaryngology, or- 
thopedics and finally anesthesiology. 

Shipley resigned in 1948, many 
changes and improvements having taken 
place in the medical school and its fac- 
ulty during his tenure. He found time to 
write, teach, lecture and operate, and he 
gained local, statewide and national rec- 
ognition. It is a tribute to Dr. Shipley's 
industry and tenacity that he, without 
any college education, became an out- 
standing figure in the surgical world. A 
great deal of his time after retirement 
was spent in caring for his bedridden 
wife. He died in his sleep, apparently 
from a cerebral accident, October 16, 
1955, at age 77. 




Charles r. edwards 

Charles Reid Edwards (acting profes- 
sor 1948-55) was born in Medley, W. 
Va., September 19, 1888. His early edu- 
cation was received at a small country 



high school in Frederick County, Md. 
After working a year or two, he applied 
for admission to the University of Mary- 
land Medical School where he received 
his M.D. in 1913 as an honor student. 

Following graduation he served as in- 
tern and resident surgeon at the Univer- 
sity Hospital under Drs. Winslow and 
Sproul. From 1915 to 1917 he was resi- 
dent surgeon at the Kernan Hospital for 
Crippled Children under Dr. R. Tunstall 
Taylor. His first appointment on the 
Maryland faculty was as assistant in or- 
thopedic surgery. In 1917 he entered the 
Army as a first lieutenant and served 
overseas with the French in Belfort, 
France. He was made a captain upon dis- 
charge. 

Returning to Baltimore in 1918 he 
began the practice of general surgery 
and rose through the different ranks to 
that of clinical professor of surgery in 
1931. Upon retirement of Dr. Arthur Shi- 
pley in 1948, he became acting head of 
the department and served in this capac- 
ity until 1955. 

A man of average stature, handsome, 
dignified, always impeccably dressed, he 
was the epitome of what a surgeon 
should look like and what a surgeon 
should be. Though not a particularly 
good lecturer, he was an excellent 
teacher at the bedside and in the opera- 
tion room. He was doubtless the most 
dexterous surgeon at the University Hos- 
pital during his time — smooth, com- 
posed, rapid and an almost faultless 
technician. At University Hospital he was 
the first to perform a number of opera- 
tions. Though none were original with 
him, he at times made it appear by the 
ease of performance that he invented 
them. He was first to perform the mod- 
ern type of gastrectomy, first to remove 
the gallbladder below-upward, first to 
perform the Bancroft operation, the De- 
vine procedure and the Whipple (pan- 
creaticoduodenectomy). He was first to 
perform lumbar ganglionectomy for a 
number of diseases. He was a strong be- 
liever in aseptic anastomoses for gastro- 
intestinal lesions. 

He possessed great stamina for work 
and in later years enjoyed a large prac- 
tice. Edwards was well-known throughout 
Maryland and a great many doctors and 
their families became his patients. It is 
recalled that he was an artist as a surgi- 
cal consultant to other surgeons, truth- 



49 



ful, tactful, leaving the patient and sur- 
geon both feeling very well indeed. 

Because of his clinical training, the 15 
papers he published dealt extensively 
with clinical subjects. He enjoyed mem- 
berships in a number of societies includ- 
ing the American Surgical Association, 
the Southern Surgical Association, the 
Society of Clinical Surgeons, the Ameri- 
can College of Surgeons (serving as a 
governor from Maryland for some years), 
the Society for Surgery of Trauma as well 
as local and state societies. He served as 
president of the Baltimore Medical So- 
ciety and the Medical and Chirurgical 
Faculty of Maryland and vice-president of 
the Southern Surgical Association. 

As a student he was a member of the 
Nu Sigma Nu medical fraternity and was 
keenly interested for decades in the af- 
fairs of this organization — he was the 
"Consultant Father" of Nu Sigma Nu. 

He traveled extensively to medical 
meetings, and took holiday trips in the 
United States and Europe. His favorite 
hobby was golf. 

Dr. Edwards is another example of a 
man with a minimum of premedical edu- 
cation, who became a surgeon and 
teacher of renown. He resigned as acting 
professor of surgery in 1955 and contin- 
ued with private practice until several 
years before his death. He became ill in 
1963 and died February 1, 1965 of car- 
cinomatosis originating from cancer of 
the prostrate gland. 




robert w. buxton 

Robert William Buxton (tenure 1955- 
70) a native of Joplin, Mo., was born Oc- 
tober 3, 1909, the son of Cora (nee 



Comer) and Warren Buxton. After prelim- 
inary education at the local schools he 
matriculated at the University of Kansas 
where he received a B.S. in 1931 and his 
M.D. in 1936. 

Following his graduation from Kansas, 
he interned at the Strong Memorial Hos- 
pital, Rochester, N.Y., and was an assist- 
ant resident in pathology and an assist- 
ant resident in surgery. In 1940 he was 
appointed resident surgeon at the Gene- 
see Hospital in Rochester, N.Y., and the 
following year returned to Strong Memo- 
rial as resident surgeon. 

After completion of a general surgical 
residency in New York, he was appointed 
resident in thoracic surgery at the Uni- 
versity of Michigan. In 1943 the doctor 
received an M.S. from Michigan. He re- 
mained at the University of Michigan 
from 1942 until 1955 serving as an in- 
structor in surgery, an assistant profes- 
sor of surgery and later as an associate 
professor of surgery. 

In 1955 at age 46, Buxton was ap- 
pointed as the ninth professor of surgery 
at the University of Maryland School of 
Medicine. He was the first fulltime pro- 
fessor appointed to the chair of surgery 
at Maryland. 

The school since its founding and until 
almost Civil War era, was theoretical in 
its teaching. After the Civil War, following 
the French, the teaching was almost en- 
tirely clinical. This dominant clinical ap- 
proach lasted until after World War 11. In 
the early fifties following the general trend 
throughout the nation, the school went 
"fulltime." Great increase in funds from 
the state, grants from the federal govern- 
ment and private sources, proved a great 
largess to a school which had been want- 
ing for funds or was nearly impoverished 
during most of its existence. Now the 
school was geared to add to its excellent 
clinical record, research and experimental 
work. Rapidly all department heads be- 
came fulltime as did most of the section 
heads and their staffs. Nearly all appoint- 
ments were with a salary and ceiling — 
overages returning to the various depart- 
ments. Curriculum was diligently studied 
and changes instituted. Gradually, most 
of the parttime staff, who had carried on 
the teaching load faithfully for years, 
moved to other hospitals. 

Into this changed environment Buxton 
became the new department head. For 
the first time there was a fulltime profes- 



sor to devote his entire time to teaching 
and the administrative affairs of the de- 
partment unencumbered by the necessity 
of earning a livelihood by practicing his 
profession. The surgeon, well-trained in 
experimental as well as clinical medicine, 
had a new approach and quickly a more 
academic atmosphere prevailed. Fulltime 
devotion to the teaching of students and 
training of house officers was the object. 
The budget for the department of sur- 
gery and its sections was around 
$60,000 when he arrived. In 1970 the 
budget for the department of general 
surgery and its specialties was $1.8 mil- 
lion. The Maryland Legislature of decades 
past could not have dreamed of such 
grants to the university. Much of these 
funds were necessary for salaries for the 
slowly increasing fulltime faculty and 
steadily increasing salaries for house of- 
ficers, laboratories and expensive equip- 
ment with the necessary paramedical 
help. 

Buxton brought a great deal of enthu- 
siasm and energy to his new task. He 
was portly, above average height, a con- 
servative dresser, of good posture, of 
very regular and moderate habits. As a 
person he was a warm, courteous, 
friendly, industrious man of great stam- 
ina. Never vindictive, he was perhaps too 
kind on many occasions and not forceful 
enough to run the "tight ship," pre- 
viously so strongly exemplified by the 
many professors who were martinets. 
However, he possessed such a great 
amount of integrity and seemed to have 
such faith in man, that it was hard for 
him to think ill of anyone. He was not so 
naive as not to recognize poor perform- 
ance, but was reluctant to chastise and 
chose instead to correct by exemplary 
methods. 

Teaching was the forte of Dr. Buxton, 
at any level of training, and it seemed 
equally enjoyable to him whether at the 
1 bedside, conference room or auditorium. 
He was a frequent visitor and speaker at 
other medical schools throughout the 
country as well as at national and local 
societies. At open conferences he pos- 
I sessed the remarkable ability of compre- 
i hensive recall on a great variety of sub- 
jects. 

Probably his most singular contribu- 
' tion to the many house officers he 
► trained was his teaching of physiology 
I and pathological physiology. He was in- 



sistent that his trainees think constantly 
in this field in their approach to the 
correction of disease. His constant query 
as regards diagnosis, choice of procedure 
or medication advised was, "Why?" His 
grasp of the general field of medicine 
was extraordinary, and superior to that 
of most surgeons. His knowledge of dia- 
betes, cardio-respiratory problems, hema- 
tologic and other medical disorders was 
certainly more than superficial as became 
readily apparent at rounds or at confer- 
ences. (Personally, I know of no other 
professor of surgery in the country who 
actually and constantly spent so many 
hours teaching.) 

He was always available to consult, to 
operate, or to assist his resident staff 
with surgical problems. Whether the 
problem involved surgery of the thorax, 
abdomen or periphery, he was equally 
adept and masterly. His technical finesse 
was such that difficult and complicated 
problems in surgery were made to ap- 
pear routine. The operations he per- 
formed were neat, precise and rapid. As 
an assistant to the residents, he was a 
superb instructor, and as patient and tol- 
erant to the beginner as a master of the 
art could be. No surgical procedure re- 
gardless of its magnitude seemed out- 
wardly to disturb him. Yet, he was no 
prima donna and his manners in the op- 
eration room were impeccable. He strived 
to make each procedure a perfect dem- 
onstration of the most proper methods of 
performance. 

Though his main vocation as well as 
avocation was surgery, he did have other 
interests. He was a bibliophile and over 
the years had invested heavily in a fine 
collection of books which included a 
number of first editions. He was also 
quite a philatelist and quite a gourmet. 
He thoroughly enjoyed his planned menus 
at the Maryland Club or elsewhere when 
entertaining a group of friends. His yearly 
trips to Europe stimulated his interest in 
wines and he became a connoisseur. He 
enjoyed fine music and in lighter mo- 
ments admitted to playing the cello in 
his youth. 

Buxton was a member of over twenty 
surgical societies including: the American 
Surgical Association, the Society of Uni- 
versity Surgeons, Southern Surgical Asso- 
ciation, Central Surgical Association, So- 
ciety of Vascular Surgery, International 
Society of Angiology, American College of 



51 



Surgeons (he later was governor to the 
College from the state of Maryland). The 
Fred Coller Surgical Society, in which he 
served as president In 1969, was of par- 
ticular interest to him. 

The 80-odd publications by the doctor 
alone and with other authors revealed his 
broad interest in the discipline of sur- 
gery. 

Dr. Buxton, aged 60, died August 14, 
1970 in Timisoara, Rumania, from inju- 
ries he received in an automobile acci- 
dent August 10, 1970 near that city. He 
was vacationing in Europe when the acci- 
dent occurred. Memorial services were 
held and his remains placed in a vault at 
a Baltimore Mausoleum. 



references 



1. Callcott, G. H.: A History of the University 
of Maryland, Maryland Historical Society, 
1966. 

2. Chew, S. C: Address Commemmorative 
of Dr. Nathan R. Smith, Trans. Medical 
and Chirurgical Faculty of Maryland, 
pp. 7-63, April 1878. 

3. Cordell, E. F.: University of Maryland, 
1807-1907, Lewis Publishing Co., Vol. I, 1907. 

4. Edwards, C. R.: Obituary, Bulletin, School 
of Medicine, University of Maryland, 

Vol. 50, 1965. 

5. Halsted, W. S.: Operative Story of Goiter, 
Halsted Papers, Vol. I, 1924. 

6. Johnston, C: "Pastic Surgery," International 
Encyclopedia of Surgery, Vol. I, pp. 531-549, 
1881. 

7. Lomas, A. J.: "As It Was in the Beginning," 
Bulletin, School of Medicine, University of 
Maryland, Vol. 23, p. 182, 1939. 

8. Peter, Robert: The History of the Medical 
Department of Transylvania, J. P. Morton 
& Company Printers, Louisville, Ky., 1905. 

9. Shipley, A. M.: Retirement, Bulletin, 
School of Medicine, University of Maryland, 
Vol. 33, p. 107, 1948. 

10. Shipley, A. M.: "Clinical Teaching," Hospital 
Bulletin, University of Maryland, p. 227, 
1907-1909. 

11. Smith, Emily: The Life and Letters of 
Nathan Smith, Yale University Press, 1914. 

12. Smith, N. R.: "Extirpation of the Thyroid 
Gland," North American Archives of 
Medicine and Surgery, 1835. 

13. Smith, N. R.: "Treatment of Fractures of 
the lower extremity by the use of anterior 
suspensory apparatus," Kelly & Piet, 
Baltimore, Md. 1867. 

14. Tiffany, L. Mc: Biographical tercentenary 
of Maryland, p. 317, 1925. 

15. Tiffany, L. Mc: Dedication, The Hospital 
Bulletin, University of Maryland, pp. 3-10, 
12-14, 1914. 

16. Warfield, R.: Address in presenting 
testimonial to Dr. Winslow, Bulletin, School 
of Medicine, University of Maryland, 

Vol. 14, pp. 8-19. 

17. Winslow, R.: Recordings of Testimonial 
Dinner, Bulletin, School of Medicine, 
University of Maryland, Vol. I, pp. 112, 1916. 

18. Winslow, R,: Hospital Bulletin, University 
of Maryland, Vol. IX, 1913. 

19. Winslow, R.: Obituary, Bulletin, School of 
Medicine, University of Maryland, Vol. I, 
p. 12, 1916. 




hyperbaric chamber care 




sign in please 




Over 50 physicians and graduates of the School oF Medicine attended the American Medical Associa- 
tion convention in Atlantic City, June 20-24. 




Dr. Edward F. Cotter, president Medical Alumni Association, discusses physician data with Robert J. 
Atkins, president, Fisher-Stevens Inc. Atkins' firm secures data on graduates which will be used by 
alumni association in keeping in touch with its alumni. 




Dr. John C, Dumler Sr.. center. Dr. Theodore Kardash, past president, Medical Alumni Assn., talk to 
a guest during a reception given by the Maryland alumni group. 




The following School of Medicine grad- 
uates attended the AMA convention in At- 
lantic City, June 20-24. 



.^1 .' 








- \ 


^^^^^rf^^S^I 


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BiLi 



John F. Cadden '27 
Bernard J. Cohen '27 
Bernard Friedman '28 
Lewis P. Gundry '28 
Abraham A. Silver '28 
Fred S. Weintraub '28 
Herman Cohen '29 
John J. Haney '29 
Meyer M. Baylus '30 
Melvin B. Davis '31 
Emmanuel A. Schimunek '31 
Arthur G. Siw/inski '31 
John C. Dumler '32 
Joseph W. Grosh '32 
Arthur Karfgin '32 
Lauriston L. Keown '33 
Hyman Schiff '33 
Lawrence J. Cohen '34 
Robert H. Dreher '34 
William L. Howard '34 
Emanuel M. Satulsky '34 
Benjamin \. Slegel '34 
John Snyder '34 
S. Jack Sugar '34 
Edward F. Cotter '35 
William G. Helfrich '35 

D. McClelland Dixon '36 
Thomas G. Abbott '37 
William A. Dodd '38 
Sylvan C. Goodman '38 
Raymond M. Cunningham '39 
Herbert Lapinsky '39 
Leiand B. Stevens '39 

T. Edgie Russell Jr. '40 
Theodore Kardash '42 

E. Roderick Shipley '42 
John M. Bloxon III '44 
Charles F. O'Donnell '44 
George W. Knabe Jr. '49 
Max Miller '49 
Frederick L. Hatem '51 
Harry L. Knipp '51 
Leonard H. Flax '53 
Albert B. Bradley '55 
Peter Thorpe '55 
William Dunseath '59 
Paul G. Koukoulas '59 
Julleta D. Grosh '69 

Ali H. Afrookteh 




Dr. and Mrs. Lauriston L. Keown 

'33 enjoy the reception which over 100 physicians 

and their wives attended. 



J 

55 




alumni activities 

Dr. William H. Triplett BMC '11 was 
married September 4 to Mrs. Nola 
Banks. 

Mrs. Banks, born and raised in North 
Carolina, and Dr. Triplett were married in 
a country church built by his father in 
West Virginia. The grounds and the build- 
ing were presented to the Presbyterian 
Church by the Triplett family and Dr. Tri- 
plett's name is on the cradle roll there. 

John W. Robertson '09, Onancock, Va., 
has been honored for his devoted and 
outstanding service to the Eastern Shore 
community of Virginia. He was presented 
a silver bowl to Onancock Mayor A. B. 
Hartman in recognition for his 60 years 
of general practice in the Virginia com- 
munity. 

the 30's 

Isadore Kaplan '37, director of medi- 
cal services for the Chesapeake and Ohio 
and Baltimore and Ohio Railroads, has 
been elected chairman of the medical 
section of the Association of American 
Railroads. 

John F. Schaefer '38, general practi- 
tioner from Catonsville, Md., is the presi- 
dent of the Maryland State Medical So- 
ciety, formally known as the Medical and 
Chirurgical Faculty. 



the 40's 

Charles Herman Williams '42, 
Pasadena, Md., has passed his Diplo- 
matic American Board of Family Practice. 

Capt. Ralph K. Brooks '43, Medical 
Corps, U.S. Navy, has retired after 28 
years of active duty and is now serving 
as director of medical services for the 
Maryland Division of Corrections. 

R. V. Rangle '43, who holds a degree 
of Juris Doctor from the University of 
Baltimore, was recently admitted to the 
Maryland Bar. 

the 50's 

James D. Shepperd Jr. '58 has been 
named medical director of the East Balti- 
more Medical Plan and assistant profes- 
sor of medicine at the Johns Hopkins 
University School of Medicine. 

the GO'S 

Stanley I. Music '66, Jacksonville, Fla., 
is currently an officer with the Epidemio- 
logic Intelligence Service, U.S. Public 
Health Service for two years. 

Robert S. Widmeyer II '68 is an ortho- 
paedics resident at Charlotte Memorial 
Hospital, Charlotte, N.C. 



102 and counting . . . 



One hundred years of life is difficult to 
realize. Start with the reconstruction 
days of the South to Montana in the 
1890's, Pancho Villa and the Mexican 
campaign, General "Blackjack" Pershing 
and World War I, and capsulize the hap- 
penings from the Depression to the moon 
exploits of the present era. 

Sounds fantastic to imagine that an in- 
dividual has lived through such momen- 
tous times and changes, but it's true. 

And, Col. William A. Wickline, M.D., 
who celebrated his 102nd birthday on 
August 27, "is still practicing" and par- 
ticipating in his second century of activity 

"He makes the rounds at the Plum 
Tree Convalescent Hospital in San Jose 
where he is a patient checking on the 
others there," said one of his daughters, 
Mrs. Edith Kennedy of Saratoga, Calif. 
"My father has a lifetime license; I guess 
they never thought he'd live to be 102." 

Mrs. Kennedy said that he first day 
her father was at Plum Tree he wrote 
himself a prescription and asked the 
nurse to have it filled. The nurse, con- 
fused, called Col. Wickline's physician 
and asked what she should do. The phy- 
sician replied, "He's a doctor, so I guess 
you'd better fill it." 

The retired Army Colonel, who was 
born August 27, 1869 in Sweet Chaly- 
beate Springs, Va., began his life on a 
farm and he paints a verbal picture of 
days in the South, after the Civil War, by 
remembering a large house and the self- 
sustaining aspect of life then. 

"One room of the house was what you 
would call a utility room now, except our 
appliances were of a different sort. We 
had a loom for weaving material using 
yarn processed from wool sheared from 
our own sheep. There was an area set 
aside for the traveling cobbler to work, 
whenever he came to make our shoes. 
We raised or grew everything we needed 
to live, to clothe and feed ourselves. We 
even had maple sugar trees and made 
our own syrup," he said. 

He graduated from Concord College in 
West Virginia and in 1895 from the Col- 
lege of Physicians and Surgeons in Balti- 
more which is now the University of 
Maryland School of Medicine. Wickline is 
the oldest living graduate of the medical 
school. 



He then joined in the exodus to settle 
the West and opened his first medical 
practice in Montana. Wanting to become 
acquainted with the world around him, he 
joined the Army in 1900 and was imme- 
diately assigned to duty in the Philippine 
Campaign. 

On the island of Panay, with the 44th 
Regiment of Volunteers, for a year, was 
the beginning of an Army medical career 
that lasted until Aug. 31, 1933. He is 
now the oldest living medical officer in 
the United States. 

Another daughter, Marian E. Wickline 
of Danville, Calif., said her father drove a 
car until he was 95 and filled out his 
own income tax until about a year ago. 
He still enjoys keeping up with his own 
financial business. 

"He visits us on weekends," said Mrs. 
Kennedy, "or we take him to Danville to 
visit there. He stands perfectly erect, has 
a perfect sense of balance and is quite a 
great man. At this rate he'll out live us 
all." 

The agile and alert Wickline speaks 
these days of visiting his relatives in Vir- 
ginia around the Richmond area, but no 
one is sure he will be able to go back. A 
thiird daughter, Mrs. Kenneth Bradshaw, 
lives in Manson, Wash. 

When asked the standard question put 
forth to anyone over 80 as to what he at- 
tributed his longevity to he replied: "A 
good active life and no bad habits. I 
don't smoke, I will have an occasional 
glass of wine and I do enjoy my coffee. 
My main recreation is reading and play- 
ing cards. I am a baseball fan and a 
rooter for the 49er's." 

In an interview on his hundredth birth- 
day he expressed pride over the techno- 
logical advancements he has witnessed in 
his lifetime. He still evidenced his love 
for travel and adventure when he com- 
mented, "We will receive many dividends 
from our moon explorations. Wouldn't 
mind going myself but I don't know if I'd 
live long enough to make it back." 

Two years and several moon launches 
later. Col. Wickline is very much alive 
and active . . . perhaps he could have 
made a moon trip too. 



57 




ALUMNI ASSOCIATION SECTION 



OFFICERS 

President 

Edward F. Cotter '35. M.D. 

President-elect 

Henry H. Start2man Jr. '50, M.D. 

Vice-presidents 

John H. Hornbaker '30, M.D. 
Benjamin M. Stein '35. M.D. 
William S. Womack '48, M.D. 

Secretary 

Robert B. Goldstein "54, M.D. 

Treasurer 

Arlie Mansberger '47. M.D. 

Executive Director 

William H. Triplett '11 BMC, M.D. 

Executive Administrator 
Francis W. O'Brien 

Executive Secretary 

Louise P Girkin 

Members of Board 

William J. R. Dunseath '59. M.D. 
William H. Mosberg Jr. '44, M.D. 
Charles E. Shaw '44. M.D. 
Joan Raskin '55, M.D. 
Donahj T. Lewers '64, M.D. 
Clift Ratlitf '43. M.D. 
Joseph S. McLaughlin '56. M.D. 
Aristides Alevizatos '60. M.D. 
John F. Strahan '49, M D. 

Ex-officio Members of Board 

Wilfred H. Townshend Jr. '40, M.D. 
Theodore Ka'dash '42. M.D. 
John H. Moxley III, M.D. 



Dear Fellow Alumni: 

How to make the Alumni Association more helpful and 
useful to the members and indeed to all graduates of the 
medical school, has been a chronic question repeatedly de- 
liberated by the officers and members of the board. Alumni 
Day and the Bulletin have been our main efforts with student 
loans an important consideration within our financial re- 
sources. 

Receptions and cocktail parties at the annual meetings 
of the American Medican Association and the Southern 
Medical Association have been held in recent years. I can 
report favorably about the reception at the AMA meeting 
in Atlantic City this past June. More on the meeting is cov- 
ered elsewhere with photographs by Francis W. O'Brien, 
executive administrator. 

As part of the Medical and Chirurgical Faculty of Mary- 
land's semiannual meeting Sept. 15-19 in Puerto Rico, we 
at the time this goes to press, are planning a luncheon or 
reception for Sept. 17 for those attending from Maryland. 
Again this year in response to an invitation from Dr. Ben- 
jamin M. Stein '35 a group from Maryland will participate 
in a meeting Oct. 16 at the Brunswick Hospital Center, 
Amityville, N.Y. 

The Southern Medical Association will meet in Miami 
Nov. 1-4 and a reception will be held Nov. 1 at the Hotel 
Fontainebleau. I hope all who are in Florida at this time 
will be able to attend. 

Alumni in the Washington, D.C. area held their annual 
luncheon Sept. 14 at the Statler Hilton. 

A number of favorable comments about recent changes 
in the Bulletin can be attributed largely to the efforts of 
Miss Jan Walker, who was appointed managing editor, Jan- 
uary 1971. The Bulletin is a joint effort of the Alumni Asso- 
ciation and the medical school. The first Bulletin in this 
series was published June 1916 as Bulletin of the Univer- 
sity of Maryland School of Medicine and College of Physi- 
cians and Surgeons. It was a successor to the Hospital 
Bulletin of the University of Maryland, Baltimore Medical 
College News and the Journal of the Alumni Association of 
the College of Physicians and Surgeons. The first issue was 
dedicated to Randolph Winslow, M.D., LL.D., professor of 
surgery, University of Maryland. As time progressed the 
Bulletin emphasized the publication of scientific articles in 
addition to general news about the medical school and the 
alumni, but the number of scientific journals increased so 
that the need for this as a scientific publication has di- 
minished. 

In the future, the Bulletin will include articles of general 
interest regarding activities of the medical school, the 
faculty and alumni, although scientific articles will continue 
to be published. The recently appointed Editorial Board con- 
sists of Dr. George Entwisle, Dr. Robert B. Goldstein, Dr. 
Donald T. Lewers, Dr. Arlie R. Mansberger, Dr. Frederick 
J. Ramsay, Dr. Edwin H. Stewart Jr., Dr. Wilfred H. Towns- 
hend Jr. and Dr. W. Douglas Weir. 

I hope there will be a good response to the letter re- 
ceived ifrom the Executive Administrator requesting personal 
information which will be of great future assistance. Plans 
are under way to change your mail become more per- 
sonalized. 



With best wishes, 



i otuyoAJ 




Edward F. Cotter, M.D. 
President 



students return 




59 



necrology 

Thomas P. Lloyd '96, Shreveport, La., 

has died. 
Frederick V. Beitler '06, Baltimore, Md., 

died July 1, 1971. 
Clarence V. Latimer '07, Deposit, N.Y., 

died October 29, 1970. 
Charles I. Shaffer '07, Somerset, Pa., 

died March 28, 1971. 
Joseph W. Ricketts '09, Ormond Beach, 

Fla., died November 4, 1970. 

teens 

John J. H. Powers '10, Leominster, 

Mass., has died. 
Gustave A. Gorisse '11, Dayton Ohio, 

has died. 
Walter S. Niblett '11, Baltimore, Md., 

died May 21, 1971. 
W. Frank Gemmill '13, York, Pa., 

has died. 
Mark V. Ziegler '15, OIney, Md., 

died July 24, 1971. 



Harry Goldmann '16, Baltimore, Md., 

died June 7, 1971. 
Maurice C. Wentz '16, York, Pa., 

died January 28, 1971. 

the 20's and 30's 

Theodore Wollak '27, Scottsdale, Pa., 

has died. 
James A. Miller '30, Baltimore, Md., 

died June 1, 1971. 
Clyde M. Stutzman '34, Muncy, Pa., 

has died. 
Ferdinand Fader '35, East Orange, N.J. 

died April 20, 1971. 
James B. Moran '36, Providence, R.L, 

has died. 
Harry F. White '38, Salinas, Calif., 

died April 12, 1971. 

the 50's 

Thomas W. Skaggs '53, Miami, Fla., 
has died. 



BuLLetin 



university of maryiand scliool of medicine 

Articles do not necessarily reflect the views of the School of 
Medicine, the Editorial Board or the Medical Alumni Association. 



Policy — The Bulletin of the School of Medicine 
University of fi4aryland contains scientific articles of 
general clinical interest, original scientific research in 
medical or related fields, reviews, editorials, and 
book reviews. A special section is devoted to news 
of Alumni of the School of Medicine, University of 
Maryland. 

Manuscripts — All manuscripts for publications, news 
items, books and monographs for review, and corre- 
spondence relating to editorial policy should be 
addressed to Dr. John A. Wagner, Editor, Bulletin of 
the School of Medicine, University of Maryland, 31 
S. Greene Street, Baltimore 1, Md. Manuscripts should 
be typewritten double spaced and accompanied by a 
bibliography conforming to the style established by 
the American Medical Association Cumulative Index 
Medicus. For example, the reference to an article 
should appear in the following order: author, title, 
name of Journal, volume number, pages included, and 
date. Reference to books should appear as follows: 
author, title, edition, pages, publisher, and date pub- 
lished. A reasonable number of illustrations will be 
furnished free. 

Reprints — At the time the galley proof is returned 
to the author, the publisher will insert an order form 



for reprints which are purchased directly from the 
publisher. Any delay in the return of this order form 
may result in considerable additional expense in 
obtaining reprints. 

Alumni Association News — The Bulletin publishes 
as a separate section. Items concerning the University 
of Maryland Alumni and their Association. Members 
and friends are urged to contribute news items which 
should be sent to Dr. John A. Wagner, Editor, Bulletin 
of the School of Medicine, University of Maryland, 
31 S. Greene Street, Baltimore, Md. 21201. 

Subscriptions — The Bulletin is issued 4 times a 
year. Its subscription price per annum, post paid is 
$3.00; single copies, $.75, when available. Active 
members of the Medical AJumni Association receive 
the Bulletin in connection with the payment of annual 
membership dues. Non-Alumni subscriptions should 
be made payable to the University of Maryland and 
remitted through the office of Miss Jan K. Walker, 
Managing Editor. 

Advertising — The Bulletin accepts a limited number 
of advertisements. Rates may be obtained upon appli- 
cation to Miss Jan K. Walker, Managing Editor, Dav- 
idge Hall, School of Medicine, 522 W. Lombard St., 
Baltimore, Md. 21201. 



Photo credits: Bill Clark, Philip Szczepan- 
ski and The Sunpapers. Design: Bruce 
Laine 



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